Time Delays in Accessing Stroke Care in the Emergency Department

Abstract

Abstract. Objective: To delineate components of delay within the hospital ED for patients presenting with symptoms of stroke. Methods: A prospective registry of patients presenting to the ED with signs or symptoms of stroke was established at a university hospital from July 1995 to March 1996. The ED arrival time, time to being seen by an emergency physician (EP), time to CT scan, and time to neurology consultation were obtained by medical record review. Results: The median delay (interquartile range) from ED arrival to being seen by an EP for the 170 eligible subjects was 0.42 (0.20 -0.75) hours. The median delay to CT scan was 1.88 hours (1.25 -2.67) and the median delay to neurology consultation was 2.42 hours (1.50 -3.48). Age, race, sex, and hospital discharge diagnosis had little influence on delay. Subjects arriving by emergency medical services (EMS) had a significantly shorter time to being seen by an EP (0.33 vs 0.50 hours) when compared with those who arrived by other means. Time to CT scan was shorter by 0.5 hours for patients arriving by EMS as well. These differences persisted when stratified by out-of-hospital delay times. Conclusions: These data suggest that arriving by EMS is associated with shorter times to being seen by an EP and receiving a CT scan. The influence of EMS on delays associated with rapid medical care of stroke patients reaches beyond the out-of-hospital transport phase.

Ethnic Disparities in Stroke Recognition in Individuals with Prior Stroke

“…First and foremost, poor recognition of early warning signs can result in delays in seeking proper medical care. [22][23][24] Delays in seeking care are associated with greater stroke severity, higher stroke mortality, and greater post-stroke disability. [25][26][27][28] The effectiveness of stroke medications is then decreased when treatment is delayed.…”

How Many Hospital Beds?

“…Bed unavailability also can lead to holding patients in upstream areas such as the surgical area, where long delays also may result in backups for the operating room (which is often a bottleneck area) causing the postponement or cancellation of surgical procedures. All of these situations have the potential for adverse financial as well as clinical effects (Cohen, Hershey, and Weiss 1980;Sarasin et al 1996;Morris et al 1999). And, of course, if patients experience considerable delays for a bed and/or are placed in inappropriate nursing units, patient satisfaction ratings may suffer, an increasingly important concern in the current competitive environment.…”

Organization of prehospital medical care for patients with cerebral stroke

“…Как показали многочисленные исследования, вызов бригады скорой медицинской помощи (СМП) ассоцииро-ван с более быстрой доставкой в стационар, нежели само-стоятельное обращение пациентов в больницу (поступле-ние «самотеком») [1][2][3][4][5][6][7][8][9].…”