Background and Aims:
Early recognition, accurate emergency medical services (EMS) dispatch, rapid EMS transport, and stroke team activation upon emergency department (ED) arrival have helped shorten door-to-IV rt-PA time, but EMS prenotification of stroke still remains crucial in saving time to treat a stroke patient. The objective of this project was to assess if education of EMS providers’ knowledge of prehospital stroke care resulted in increased number of stroke prenotifications and decreases door to needle time.
Methods: We conducted a quality improvement project at the ED where summer research students administered an educational survey and provided one-on-one education to EMS providers about methods to identify stroke, barriers to prenotification and best method for providing EMS feedback during the months June to August 2018. The percentage of stroke prenotifications received and door to needle times were compared from 4 months before and after the project. Using descriptive statistics we evaluated whether this short term educational intervention to EMS resulted in shortened door-to needle time in our emergency department.
Results: 301 EMS providers were surveyed and educated. Prior to the educational intervention, pre-notification for stroke was 30.9% of patients brought by EMS as compared to 33% after completion of educational surveys. Door-to Needle times for IV thrombolysis dropped significantly from a mean of 58.5 minutes prior to the intervention to 49.9 minutes after EMS one-on one education was completed.
Conclusion: One-on-one EMS education had a significant effect on decreasing door to needle time in patients receiving IV thrombolysis for acute ischemic stroke.There was a trend towards increased number of prenotifications in all stroke patients brought in by EMS.
Limitations: Need for a better process to collect prenotification information; more sample size, more longitudinal data needed to see if this intervention has a long term effect on Ems prenotification rates.