Introduction: EMS stroke prenotification (S-PN) expedites and increases tPA use. In 1/15, the New York State Dept. of Health (NYS DOH) began tracking S-PN data; however the baseline S-PN frequency and stroke teams’ S-PN experiences and practices in New York City (NYC) and Long Island (LI) had not been established.
Hypothesis: The American Heart Association American Stroke Association NYC Stroke Task Force (NYC STF), a panel of stroke clinicians from NYC and LI, sought to assess current regional S-PN experiences.
Methods: Online survey by the NYC STF was opened to NYS DOH designated stroke centers in NYC and LI from 12/8/14-1/12/15. Hospitals were instructed to respond based on the previous 12 months, using data or best estimation. Results were analyzed with frequency distributions.
Results: Response rate= 75.8% (47/62 hospitals). Respondents: Stroke Coordinators= 66.0%, Stroke Directors= 10.6%, other= 23.4%. Most hospitals received patients from Fire Dept., City of NY (n= 38) and other private/municipal EMS. Many (53.2%) reported receiving S-PN for eligible patients <50% of the time; 27.7% reported receiving S-PN 50-89% of the time; only 14.9% reported receiving S-PN 90-100% of the time. Hospital size did not affect S-PN rate. Only 37.0% reported documenting receipt of S-PN >50% of the time. ED nurses most often received initial S-PN (n= 36), followed by ED clerks (n= 17); 80.4% of hospitals gave stroke triage training to these personnel. Most hospitals (91.5%) used a single-call activation for stroke team/radiology; only 57.5% reported activating it >50% of the time before patient arrival. Contact information for kin/witness (n=37), patient name (n=27) and birthdate (n=25) were most desired to add to S-PN. Frequently perceived barriers: inconsistently receiving S-PN from EMS (n=39), incomplete S-PNs (n=24). Most hospitals (65.8%) perceived positive impact of S-PN; 34.2% perceived no impact/too early to tell.
Conclusions: In 2014, stroke teams in NYC and LI perceived wide variations in the rate of S-PN. ED nurses, clerks and EMS personnel are prime recipients for stroke triage training. Hospitals desire contact/identifying information as part of S-PN. More consistent documentation and review of S-PN data is needed to improve its impact on stroke care.