Pre-hospital stroke recognition in a UK centralised stroke system: a qualitative evaluation of current practice

Brunton, Lisa; Boaden, Ruth; Knowles, Sarah; Ashton, Christopher; Parry‐Jones, Adrian

doi:10.29045/14784726.2019.06.4.1.31

Cited by 10 publications

(11 citation statements)

References 9 publications

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“…However, significantly more suburban paramedics rated their prehospital stroke care knowledge as inadequate and indicated significantly higher stroke training demand for EMS as a whole, although an overwhelming training demand was observed in both groups. These findings are in line with other studies, showing that EMS staff members lacked stroke care knowledge [ 8 , 14 , 19 ], and regional disparities were present [ 20 ]. Studies assessing the real-world impact of EMS training show that it improves stroke recognition, increases hospital prenotification rates, improves tPA delivery time [ 10 , 11 ], and stroke transfer time to the ED [ 3 ].…”

Section: Discussionsupporting

confidence: 92%

“…Our survey revealed that only 6.2% of paramedics receive formal feedback on stroke, however, more than two-thirds of them think that hospital-directed feedback is crucial and would improve their future decision-making. These findings are in line with other studies, where formal feedback is noted as highly desirable for EMS staff members, yet not sufficient [ 8 , 10 , 12 , 13 , 14 , 19 , 28 , 29 , 30 ]. Previous studies have shown that hospital-directed feedback to EMS is associated with improved overall compliance with state protocols, increased hospital prenotification, and improved stroke timeliness metrics in patients with ischemic stroke [ 12 ].…”

Section: Discussionsupporting

confidence: 92%

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Prehospital Stroke Care, Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania

et al. 2022

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Background: Emergency medical services (EMS) are the first health care contact for the majority of stroke patients. However, there is a lack of data on the current paramedics’ hospital-directed feedback and training needs across different health care settings. We aimed to evaluate paramedics’ prehospital stroke care knowledge, training needs, and current status of feedback on suspected stroke patients. Methods: We surveyed paramedics from the Vilnius region from September to November 2019 and compared the answers between the city and the district agencies. The questionnaire content included questions on paramedics’ demographic characteristics, prehospital stroke care self-assessment, knowledge on stroke mimics, stroke training needs, and the importance of hospital-directed feedback on suspected stroke patients. Results: A total number of 161 paramedics (or 49.4% of all paramedics from our stroke care network) were surveyed, with more district paramedics rating their prehospital stroke care knowledge as inadequate (44.8% (95% confidence interval (CI) 32.8–57.6) vs. 28.1% (95% CI 20.1–27.8), p = 0.028). In addition, more district paramedics indicated a need for additional stroke training (83.1% (95% CI 71.5–90.5) vs. 69.8% (60.0–78.1), p = 0.043). However, respondents reported being the most confident while dealing with stroke (71.3%, 95% CI 63.8–77.7) compared to other time-critical conditions (p < 0.001). Vertigo (60.8%, 95% CI 53.0–68.0), brain tumors (56.3%, 95% CI 48.5–63.8), and seizures (54.4%, 95% CI 46.7–62.0) were indicated as the most common stroke mimics. Only 6.2% (95% CI 3.4–11.1) of respondents received formal feedback on the outcome of suspected stroke patients brought to the emergency department. Conclusions: A high proportion of paramedics self-perceive having inadequate stroke knowledge and an urgent need for further stroke training. The EMS staff indicate receiving insufficient feedback on suspected stroke patients, even though its usefulness is perceived as paramount.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Prehospital Stroke Care, Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania

et al. 2022

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“…In addition, significantly more suburban paramedics rated their prehospital stroke care knowledge as inadequate and indicated significantly higher stroke training demand for EMS as a whole, although an overwhelming training demand was observed in both groups. These findings are in line with other studies, showing that EMS staff members lacked stroke care knowledge [8,14,18], and regional disparities were present [19]. Studies assessing the real-world impact of EMS training show that it improves stroke recognition, increases hospital prenotification rates, improves tPA delivery time [10,11], and stroke transfer time to the ED [3].…”

Section: Discussionsupporting

confidence: 86%

Prehospital Stroke Care, Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania

Melaika¹,

Sveikata²,

Vilionskis³

et al. 2022

Preprint

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Background: Emergency medical services (EMS) are the first health care contact for the majority of stroke patients. However, there is a lack of data on the current paramedics’ hospital-directed feedback and training needs across different health care settings. We aimed to evaluate paramedics’ prehospital stroke care knowledge, training needs, and current status of feedback on suspected stroke patients. Methods: We surveyed paramedics from the Vilnius region from September to November 2019, and compared the answers between the city and the district agencies. The questionnaire content included questions on paramedics’ demographic characteristics, prehospital stroke care self-assessment, knowledge on stroke mimics, stroke training needs, and the importance of hospital-directed feedback on suspected stroke patients. Results: A total number of 161 paramedics were surveyed, with more district paramedics rating their prehospital stroke care knowledge as inadequate (44.8% (95% confidence interval (CI) 32.8–57.6) vs 28.1% (95% CI 20.1–27.8), p = 0.028). In addition, more district paramedics indicated a need for additional stroke training (83.1% (95% CI 71.5–90.5) vs 69.8% (60.0–78.1), p = 0.043). However, respondents reported being the most confident while dealing with stroke (71.3%, 95% CI 63.8–77.7) compared to other time-critical conditions (p < 0.001). Vertigo (60.8%, 95% CI 53.0–68.0), brain tumours (56.3%, 95% CI 48.5–63.8), and seizures (54.4%, 95% CI 46.7–62.0) were indicated as the most common stroke mimics. Only 6.2% (95% CI 3.4–11.1) of respondents received formal feedback on the outcome of suspected stroke patients brought to the emergency department. Conclusion: A high proportion of paramedics self-perceive having inadequate stroke knowledge and an urgent need for further stroke training. The EMS staff indicate receiving an insufficient amount of feedback on suspected stroke patients, even though the usefulness is perceived to be paramount.

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“…Ambulance clinicians do not routinely receive feedback unless there is investigation into a serious clinical issue or complaint. However, the perception of risk within a risk averse ambulance service/organization has been reported to influence prehospital decision making toward “erring on the side of caution” ( 20 ). This could be inferred from the larger proportion of mimics presented to the stroke pathway when they are local since they would have been directed to Salford Royal Foundation Trust regardless.…”

Section: Discussionmentioning

confidence: 99%

Differences in Characteristics and Ambulance Pathway Adherence Between Strokes and Mimics Presenting to a Large UK Centralized Hyper Acute Stroke Unit (HASU)

et al. 2021

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Background: In Greater Manchester (GM), prehospital clinicians use the Face Arm Speech Test (FAST) to identify suspected stroke patients alongside pathway exclusions. Within the centralized stroke service, patients with a suspected stroke are taken directly to a Hyper Acute Stroke Unit (HASU), often bypassing their local emergency department (ED). However, many of these patients are experiencing an illness that looks like a stroke but is not a stroke. The data collected in the prehospital setting is rarely used in research yet could give valuable insights into the performance of the pathway.Aim: To evaluate the presenting symptoms and final diagnoses of prehospital suspected strokes and to evaluate the adherence of prehospital stroke pathway exclusions.Methods: We analyzed data from all patients brought in by ambulance and admitted on the stroke pathway between 01/09/15 and 28/02/17. Patient demographics and all data recorded in the prehospital setting were evaluated to identify differences in stroke, TIA, and mimic patients. Pathway adherence was assessed according to whether the patient was local or out-of-area (OOA) and bypassed their local ED.Results: A total of 4,216 suspected strokes were identified: 2,213 (52.5%) had a final diagnosis of stroke, 492 (11.7%) experienced a transient ischemic attack (TIA), and 1,511 (35.8%) were stroke mimics. There were 714 (16.9%) patients that were identified as having at least one pathway exclusion or were FAST negative, of which 270 (37.8%) experienced a stroke. The proportion of strokes was significantly lower in those with a pathway exclusion (41.8 vs. 53.5%; p < 0.001) and the proportion of breaches tended to be comparable or higher in the local population.Discussion: There are high volumes of stroke mimics but identified differences indicate there is an opportunity to better utilize prehospital data. Ambulance clinicians were able to correctly overrule FAST negative results and the volume of these suggest that FAST alone may be too restrictive.

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Pre-hospital stroke recognition in a UK centralised stroke system: a qualitative evaluation of current practice

Cited by 10 publications

References 9 publications

Prehospital Stroke Care, Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania

Prehospital Stroke Care, Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania

Prehospital Stroke Care, Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania

Differences in Characteristics and Ambulance Pathway Adherence Between Strokes and Mimics Presenting to a Large UK Centralized Hyper Acute Stroke Unit (HASU)

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