Background and Purpose: In 2014, Novant Health Presbyterian Medical Center (NHPMC) and Mecklenburg EMS Agency (MEDIC) launched a collaborative project to improve stroke care in our community. The goals of the project were to: Improve the efficiency of the Code Stroke process Determine the accuracy of priority one stroke calls from EMS to the Emergency Department Identify areas of the community with greatest numbers of stroke calls Provide individual case feedback to EMS colleagues
Method: MEDIC crews call in priority one suspected acute stroke patients prior to emergency arrival. Unless stabilization is required, MEDIC takes the patient directly to the CT scanner, located in the emergency room, and assists with transferring the patient to the scanner. The accuracy of priority one calls is shared monthly and quarterly with MEDIC and the NHPMC Stroke Best Practice Team.If the patient receives t-PA, the NHPMC Clinical Analyst sends the MEDIC Quality Specialist a feedback sheet within 24-48 hours which includes dispatch to arrival and dispatch to drug time parameters and initial patient outcomes. The feedback sheets are sent via the supervisors, who also send a letter of commendation to the responding crew members.
Results: In 2013 the door to CT report time averaged 27 minutes, 2014 average was 20 minutes or a 26% reduction. In 2014, NHPMC received 80 priority one stroke calls from MEDIC crews. Of these 80 patients, 71 were coded at discharge as either strokes or stroke mimics. This number reflects 89% stroke identification accuracy. Ischemic stroke patients who received t-PA at NHPMC had a median door to drug time of 40 minutes and a median dispatch to drug time of 68.5 minutes. Density of stroke calls assisted in identification of target areas and populations for community awareness education.
Conclusion: Having a strong collaborative relationships with EMS agencies, together both EMS and hospitals can positively impact the quality of stroke care within a community. As first responders, EMS crews have a unique perspective that can improve processes and decrease time to treatment. Providing feedback information to our EMS partners helps them understand their impact on stroke patient outcomes.