Improvement in Stroke Quality Management by an Educational Programme

Abstract

Time after symptom onset in ischaemic stroke has to be as short as possible to increase success of treatment. We prospectively analysed latencies from symptom onset until the start of therapy and the rate of thrombolysis in 196 patients with suspected stroke sequentially admitted to the hospital before (6 weeks prior, n = 83) and after (n = 113) initiating an educational stroke programme (EP). A total of 345 dispatchers, paramedics, and emergency staff were trained, each person for at least 2 h. The mean pre-hospital time interval from symptom onset until admission was significantly decreased by nearly 2 h (p < 0.05). Thrombolytic therapy frequencies increased from 2 to 10.5% (p < 0.01) because the overall mean time interval from admission to the start of therapy significantly decreased (p < 0.01) by 69 min after the EP, with increasing numbers of patients suitable for acute stroke therapies within a 0- to 3-hour treatment window.

An emergency clinical pathway for stroke patients – results of a cluster randomised trial (isrctn41456865)

“…At the same time, it suggests that further efforts are necessary to teach the accurate recognition of stroke symptoms, a key concept which must be stressed in training programs [7,11,13]. Our experience indicates that integrating EMS systems and ERs for organised acute stroke care, which must include SU networks, is feasible and may ameliorate the quality of care for stroke patients.…”

“…It was organised in three successive phases: 1) interviews with health professionals to identify their learning needs; 2) training the ECP coordinators/facilitators in a residential setting; and 3) on-site training in small groups of health professionals (6)(7)(8), led by a coordinator/facilitator. The training was focused on teaching the personnel to identify stroke symptoms, by using the Cincinnati pre-hospital Stroke Scale (CSS) [19] for EMS staff or the National Institute of Health Stroke Scale (NIH-SS) [20] for ER staff; to register the time of symptom onset and age, and consider them as main inclusion/exclusion criteria for thrombolysis; to refer patients with suspected acute stroke to the Emergency Department Stroke Unit when appropriate.…”

“…The implementation of an evidence-based acute stroke care pathway for Emergency Medical System personnel, associated with continuing medical education programs may be one method to achieve this goal [7][8][9][10][11][12][13].…”

The Impact of Ambulance Practice on Acute Stroke Care

“…The results reported across these studies show an increase in the accuracy of paramedic diagnosis, reduced prehospital delays, reduced in-hospital times to treatment, and an increase in the thrombolysis rate. 5,[17][18][19][20][21][22] Little is known about the relationship between prehospital and emergency care and the impact of prehospital practice on emergency department (ED) care of patients with acute stroke. The aims of this study were to identify current patterns of care for stroke patients from the call for ambulance assistance to first medical assessment in the ED.…”

EMS Management of Acute Stroke—Prehospital Triage (Resource Document to NAEMSP Position Statement)

“…44 Physicians, nurses, CT/MR technologists, pharmacists, and others are able to use early notification to mobilize necessary resources for the patient. 5,45,46 Prehospital notification of in-bound stroke has been demonstrated to shorten delays from ED arrival until initial neurological assessment and initial brain imaging, and to increase the proportion of patients treated with reperfusion therapy, both as an individual intervention, 18,19 and as one element in the implementation of a comprehensively organized prehospital stroke care system.…”