Implementation Strategies for Emergency Medical Services Within Stroke Systems of Care

Acker, Joe; Pancioli, Arthur; Crocco, Todd J.; Eckstein, Marc; Jauch, Edward C.; Larrabee, Hollynn; Meltzer, Neil; Mergendahl, William C.; Munn, John W.; Prentiss, Susanne M.; Sand, Charles; Saver, Jeffrey L.; Eigel, Brian; Gilpin, Brian; Schoeberl, M. R.; Solis, Penelope; Bailey, JoAnne R.; Horton, Katie; Stranne, Steven K.

doi:10.1161/strokeaha.107.186094

Cited by 186 publications

(93 citation statements)

References 75 publications

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“…Currently, the use of prehospital stroke recognition tools is recommended by both the National Academy of Emergency Medical Service Physicians and the American Stroke Association. , Acker et al 2007) However, it has been estimated that more than 30% of all stroke cases are still missed by prehospital stroke scales and as much as 50% or more of cases designated as suspected stroke have been false positives (Asimos et al 2014, Brandler et al 2014, Oostema et al 2015. This burdens in-hospital stroke teams who at times have to struggle with multiple suspected stroke patients simultaneously.…”

Section: Prehospital Recognition Of Acute Strokementioning

confidence: 99%

“…This kind of data is also becoming more readily available through the implementation of electronical prehospital patient reporting and EMS data capturing systems. (Acker et al 2007 A novel approach to a prehospital stroke protocol and to minimizing the pretreatment delay has been the introduction of mobile stroke unit concept (Fassbender et al 2013). The Mobile Stroke Unit (MSU) and Stroke Emergency Mobile (STEMO) are specially-designed emergency vehicles that include a NCCT apparatus with telemedical connectivity to the neuroradiologist at local university hospital, a point-of-care laboratory kit and the necessary equipment for IVT administration.…”

Section: Development Of Prehospital Stroke Protocolsmentioning

confidence: 99%

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Stroke and the emergency medical services – enhancing performance within the chain of survival

Puolakka

2017

Acta Anaesthesiol Scand

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Section: Prehospital Recognition Of Acute Strokementioning

confidence: 99%

Section: Development Of Prehospital Stroke Protocolsmentioning

confidence: 99%

Stroke and the emergency medical services – enhancing performance within the chain of survival

Puolakka

2017

Acta Anaesthesiol Scand

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“…[15][16][17] The importance of developing regionalized systems is further supported by a number of national organizations in Canada and the United States. [18][19][20][21] Historically, the drivers of regionalized systems of care have been trauma and STEMI; however, other systems include stroke, traumatic brain injury (TBI) 22 , OHCA 4,23 , and burns…”

Section: Components Of Regionalized Systems Of Carementioning

confidence: 99%

The Role of EMS in Regionalized Systems of Care

Drennan

Verbeek

2015

CJEM

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The parallel advancement of prehospital and in-hospital patient care has provided impetus for the development and implementation of regionalized systems of health care for patients suffering from acute, life-threatening injury and illness. Regardless of the patient's clinical condition, regionalized systems of care revolve around the premise of providing the right care to the right patient at the right time. Current regionalization strategies have shown improvements in the time to patient treatment and in patient outcome, with the incorporation of emergency medical services (EMS) bypass as a key component of the system of care. This article discusses the emerging role of EMS as a critical component of regionalized systems essential to ensure effective and efficient use of resources to improve patient outcome. We also examine some of the benefits and barriers to implementation of regionalized systems of care and avenues for future research.

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“…2005), EMS systems of prehospital care (Acker et al. 2007), and protocols for EMS bypass of hospitals not capable of stroke care was recommended (Adams et al. 2007).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of regionalized systems for stroke and myocardial infarction

et al. 2015

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BackgroundAcute ischemic stroke (AIS) and ST‐segment elevation myocardial infarction (STEMI) are ischemic emergencies. Guidelines recommend care delivery within formally regionalized systems of care at designated centers, with bypass of nearby centers of lesser or no designation. We review the evidence of the effectiveness of regionalized systems in AIS and STEMI.MethodsLiterature was searched using terms corresponding to designation of AIS and STEMI systems and from 2010 to the present. Inclusion criteria included report of an outcome on any dependent variable mentioned in the rationale for regionalization in the guidelines and an independent variable comparing care to a non‐ or pre‐regionalized system. Designation was defined in the AIS case as certification by the Joint Commission as either a primary (PSC) or comprehensive (CSC) stroke center. In the STEMI case, the search was conducted linking “regionalization” and “myocardial infarction” or citation as a model system by any American Heart Association statement.ResultsFor AIS, 17 publications met these criteria and were selected for review. In the STEMI case, four publications met these criteria; the search was therefore expanded by relaxing the criteria to include any historical or anecdotal comparison to a pre‐ or nonregionalized state. The final yield was nine papers from six systems.ConclusionAlthough regionalized care results in enhanced process and reduced unadjusted rates of disparity in access and adverse outcomes, these differences tend to become nonsignificant when adjusted for delayed presentation and hospital arrival by means other than emergency medical services. The benefits of regionalized care occur along with a temporal trend of improvement due to uptake of quality initiatives and guideline recommendations by all systems regardless of designation. Further research is justified with a randomized registry or cluster randomized design to support or refute recommendations that regionalization should be the standard of care.

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Implementation Strategies for Emergency Medical Services Within Stroke Systems of Care

Cited by 186 publications

References 75 publications

Stroke and the emergency medical services – enhancing performance within the chain of survival

Stroke and the emergency medical services – enhancing performance within the chain of survival

The Role of EMS in Regionalized Systems of Care

Effectiveness of regionalized systems for stroke and myocardial infarction

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