Abstract TP258: Increasing Emergency Medical Services Pre-Notification Results in Faster Alteplase Administration and Increased Thrombectomy Therapy

Abstract

Background and Purpose: EMS pre-notification of a suspected acute stroke patient assists the hospital in mobilizing the appropriate personnel and resources before the patient arrives. The pre-notification by EMS and mobilization of the hospitals stroke team will increase the probability of the appropriately screened acute stroke patient receiving thrombolytic therapy. The Wisconsin Coverdell Stroke Program (Coverdell) performed a multi-quarter analysis of the successes and barriers hospitals were experiencing with EMS pre-notifying, with an overarching goal to increase this percentage to >80%. Methods: Coverdell’s 66 participating hospitals represent 78% of annual stroke admissions to Wisconsin hospitals. Coverdell hospitals participate in the quarterly Coverdell Learning Collaborative (CLC) where they review several aggregated data points. Of these, EMS pre-notification times are analyzed and discussed. Stroke Coordinators at hospitals’ performing at a high level shared with the CLC their performance improvement activities and best practices related to EMS pre-notification. Methods used consisted of, educating and training EMS caregivers on improving pre-arrival notification by communicating in plain language stroke symptoms or verbalizing a “possible stroke”; educating and training emergency department caregivers on where to document the EMS pre-arrival report in the EHR; and educating the stroke data abstractor on where the EMS pre-hospital report is located in the EHR. Findings: In analyzing quarterly data from Q1 2017 to Q1 2019, our multi-disciplinary approach demonstrates impressive results. EMS pre-notification rose from 68.1% to 77.0%, with 82% reached in Q2 2018. Associated with this the median DTN time for those arriving by EMS decreased from 49 to 44 minutes, with the lowest median time in Q2 2018 of 42.5 minutes. Furthermore, thrombectomy therapy (alteplase and mechanical thrombectomy) administration rates increased from 21.5% to the highest in Q2 2018 at 26.8%. Conclusion: A multi-faceted approach focused on improving communication between EMS and hospitals by pre-notifying of a suspected stroke patients arrival, has led to remarkable improvements in Coverdell’s outcome data.