Background and Purpose: The Phoenix Stroke Workgroup (PSW) is comprised of volunteer staff of doctors, nurses and EMS to focus on the partnership between EMS and PSCs. Data is collected and shared within this workgroup to examine the delivery of emergent stroke care at each specific facility.
PSW evaluated yearly data by voluntary submission of predetermined critical metrics. PSW established benchmarks and set limits for each measure (i.e. Door to Needle (DTN) benchmark was 45 min with a limit of 75 min). Facilities exceeding the set limits were required to implement an action plan, review by EMS, and submit the next two quarters data for review by PSW.
We aim to determine if this collaboration has improved patient care, specifically: door to needle (DTN) times, complication rates, rates of tissue plasminogen activator and endovascular stroke treatments.
Methods: Stroke coordinators volunteered all facility data from Get With The Guidelines AHA data base yearly with coordination from the local AHA chapter. We then compared clinical metrics from the 19 PSC’s for the years 2014, 2015, and 2016 for door to needle (DTN) times, complication rates, rates of tissue plasminogen activator and endovascular stroke treatments.
Results: This collaboration decreased EMS DTN and POV (private vehicle) DTN times by 8 minutes and 9 minutes respectively during the 3-year study period. The utilization rate of TPA and endovascular treatment increased from 13.8 to 14.7% and 3 to 4.4%, but complications increased 2% from 3 to 5%.
Conclusion: PSW collaboration improved the DTN times and utilization of both TPA and Endovascular treatment in the Phoenix metropolitan area. Future directions include collaboration to evaluate endovascular treatment times, bypass or transfer policies and statewide collaboration to continue to improve stroke patient care.