Background: Arrival to the emergency room (ER) by ambulance services and prior notification have been identified as major factors for reducing Door to CT and Door to needle time with thrombolysis for patients with acute stroke. Unfortunately despite all efforts to increase the awareness of using ambulances, still 40-50% of patients arrive by private transportation without prior notification of the ER.
Objective: We evaluated if a standardized seven item screening questionnaire, performed at the admission office of the ER, can reduce time to triage nurse evaluation and subsequently time of arrival to CT, for patients with acute stroke arriving to the ER without prenotification of the ER.
Methods: Since April 2016 a standardized screening questionnaire was performed by the admission clerks at the ER arrival for any patient not referred by prior notification for stroke. This questionnaire included seven major stroke symptoms and time of onset of the symptoms. If one of these symptoms started less than 8 hours before the arrival to the ER the patient was urgently referred to the triage nurse which would then evaluate urgently and activate the a Stroke Code. Patient data was collected of all patients admitted to the ER with a suspected stroke between April-June 2015 and April-June 2016 and time intervals for Door to triage nurse and Door to CT were compared for patients admitted to the ER with suspected Stroke between the time period without questionnaire and with.
Results: In the relevant time periods 143 stroke patients were admitted to our ER. Median time from arrival to triage nurse was 16 min (n=96) in 2016 compared to 28 min (n=47) in 2015 (p>0.0001). Patients arriving within 8 hours form symptom onset the median time for arrival to triage nurse was 15 min (n=49) and 28min (n=14) respectively (p=0.006). Median time from arrival to ER to CT brain was 29 min(n=18) for the group that was screened by an early seven point questionnaire at ER admission and stroke code activated versus 78 min(n=14)without early screening and stroke code activation(p=0.069).
Conclusion: A standardized seven item stroke symptom questionnaire as an early ER admission screening method can reduce time intervals from arrival to CT for self-referral stroke patients without prior notification of the ER.