Abstract 268: Evaluating Pre-Hospital Response When Stroke Symptoms are Present Though Hospital Arrival Mode and Last Known Well to Arrival Times
Background: Delay in hospital arrival for stroke patients continues to be a persistent problem in Wisconsin (WI). Research shows outcomes are better with earlier arrival and treatment with IV tPA. The proportion of patients activating 911 and arriving quickly after a stroke has not improved over time. Arrival via EMS versus private transport has seen a slight decrease.
Purpose: Evaluate the trends of patient arrival mode and trends of last known well to arrival time in order to work collaboratively with state partners on public awareness of stroke signs,symptoms and importance of calling 911.
Methods: Two benchmarking groups were established in WI through the Get With The Guidelines Patient Management tool: the All WI hospital benchmark and the WI PSC benchmark. The benchmarks include 65 WI hospitals and 27,197 stroke records between 2009 and 2012. We evaluated trends in onset-to-arrival times and use of EMS among stroke patients in both benchmark groups.
Results: During the study period, approximately 22% of stroke patients arrive to hospital within 120 minutes of time last known well with no change over time despite stroke systems work throughout the state. Onset-to-arrival times were similar at Wisconsin PSCs versus any Wisconsin hospital. Arrival by EMS has decreased over time at both PSCs (44% in 2009 to 30.1% in 2012) and all hospitals (35.6% in 2009 to 32% in 2012).
Conclusions: Many stroke patients do not activate 911 or arrive to a hospital in a timely manner. Collaborative attempts by state partners to provide education to the public has not made much difference in arrival mode and arrival from time last known well. Structured outreach activities utilizing initiatives such as the American Heart Association’s signs and symptoms materials can continue to be utilized, but a more comprehensive plan among state stakeholders, EMS, hospitals and the AHA will need to be developed to improve patient awareness and subsequently patient arrival times, resulting in better outcomes.
Author Disclosures: J. Pittenger: None. S. Fuhrman: None. A. Hansen: None. C. Etter: None. K. Polum: None. K. Watkins: None. M. Gardner: None.
- © 2014 by American Heart Association, Inc.