The Quality of Prehospital Ischemic Stroke Care: Compliance with Guidelines and Impact on In-hospital Stroke Response

Autor: John A Oostema, Mathew J. Reeves, Mojdeh Nasiri, Todd Chassee
Rok vydání: 2014
Předmět:
Male
Emergency Medical Services
Michigan
medicine.medical_specialty
Multivariate analysis
Quality management
Logistic regression
Brain Ischemia
Time-to-Treatment
Brain ischemia
Odds Ratio
medicine
Emergency medical services
Humans
Thrombolytic Therapy
Prospective Studies
Practice Patterns
Physicians'
Prospective cohort study
Stroke
Aged
Quality Indicators
Health Care
Aged
80 and over
business.industry
Emergency Medical Service Communication Systems
Process Assessment
Health Care
Rehabilitation
Odds ratio
Middle Aged
medicine.disease
Hospitals
Logistic Models
Transportation of Patients
Treatment Outcome
Multivariate Analysis
Practice Guidelines as Topic
Physical therapy
Female
Surgery
Guideline Adherence
Neurology (clinical)
Tomography
X-Ray Computed
Cardiology and Cardiovascular Medicine
business
Zdroj: Journal of Stroke and Cerebrovascular Diseases. 23:2773-2779
ISSN: 1052-3057
DOI: 10.1016/j.jstrokecerebrovasdis.2014.06.030
Popis: Background A number of emergency medical services (EMSs) performance measures for stroke have been proposed to promote early stroke recognition and rapid transportation to definitive care. This study examined performance measure compliance among EMS-transported stroke patients and the relationship between compliance and in-hospital stroke response. Methods Eight quality indicators were derived from American Stroke Association guidelines. A prospective cohort of consecutive, EMS-transported patients discharged from 2 large Midwestern stroke centers with a diagnosis of acute ischemic stroke was identified. Data were abstracted from hospital and EMS records. Compliance with 8 prehospital quality indicators was calculated. Univariate and multivariable logistic regression analysis were performed to measure the association between prehospital compliance and a binary outcome of door-to-computed tomography (CT) time less than or equal to 25 minutes. Results Over the 12 month study period, 186 EMS-transported ischemic stroke patients were identified. Compliance was highest for prehospital documentation of a glucose level (86.0%) and stroke screen (78.5%) and lowest for on-scene time less than or equal to 15 minutes (46.8%), hospital prenotification (56.5%), and transportation at highest priority (55.4%). After adjustment for age, time from symptom onset, and stroke severity, transportation at highest priority (odds ratio [OR], 13.45) and hospital prenotification (OR, 3.75) were both associated with significantly faster door-to-CT time. No prehospital quality metric was associated with tissue-plasminogen activator delivery. Conclusions EMS transportation at highest priority and hospital prenotification were associated with faster in-hospital stroke response and represent logical targets for EMS quality improvement efforts.
Databáze: OpenAIRE
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