Background: Prompt recognition by emergency medical services (EMS) and emergency department (ED) triage is paramount in the treatment and survival of the stroke patient. We hypothesized that providing prompt feedback to EMS and ED on stroke care may improve EMS and hospital metrics and raise the hospital’s defect free care.
Objective: To determine if the feedback provided to EMS and ED would improve the metrics and patient outcome.
Method: A retrospective analysis comparing the percent of patients met the metrics prior to and after initiation of the feedback tools. Feedback forms were developed May 2015, education provided on forms Jun 2015, and implemented Jul 2015. Feedback was provided on all patients called in as a SA, BA on arrival, and/or patients with a discharge diagnosis of stroke.
Results: Comparing the first six months prior to the feedback tool (127 BA in ED and 31 EMS SA) with the six months after (173 BA in the ED and 79 EMS SA) the Get with the Guideline (GWTG) timeline goals in the ED improved (Time of Arrival (TOA) to MD, goal 10 minutes, May 2015 35% to Dec 2015 100%; TOA to Neurology Consult, goal 15 minutes, May 2015 65% to Dec 2015 82%; TOA to Cat Scan (CT), goal 25 minutes, May 2015 41% to Dec 2015 79%; TOA to CT read, goal 45 minutes, May 2015 12% to Dec 2015 71%; TOA to t-PA, goal 60 minutes, May 2015 0% to Dec 2015 80%; CT ordered as a stroke, May 2015 21% to Dec 2015 84%; dysphagia screening prior to by mouth, May 2015 29% to Dec 93%) and the number of stroke alerts increased (pre-notification rates Q1/Q2 26.3%; Q3/Q4 56.8%). The hospital’s stroke defect free care in Q1/Q2 (77.3%) increased in Q1/Q2 2016 (97.2%). With the improvements in the EMS, ED, and hospital metrics, length of stay (LOS) decreased (Q1/Q2 5.77 days to Q3/Q4 5.05 days) and more patients were discharged with a lower modified Rankin Scale (mRS) (Q1/Q2 mRS 0-3 33%; Q3/Q4 mRS 0-3 48%).
Conclusion: The EMS and ED metrics improved and continue to improve despite a growing and thriving neurology service. By providing the stroke care feedback, EMS and ED developed a more vested interested in the patient’s outcome. Based on the response from the EMS and ED staff on the stroke feedback tools, it is the most expedient and efficient way to communicate and continually educate on the care of the stroke patient both pre-hospital and in hospital.