Prehospital notification of suspected stroke patients to a dedicated stroke team improves access to reperfusion therapies [Meeting Abstract]

Abstract

Background: A previous audit demonstrated that nurse-led triage of stroke calls from the emergency department (ED) improved time metrics for diagnostics and thrombolysis in our centre. Our local ambulance service recently introduced a screening tool to identify acute stroke patients and facilitate prehospital notification. This was introduced despite concern regarding possible inappropriate prenotification (e.g. stroke mimics and ineligible strokes). We sought to determine whether introduction of the tool was associated with improved metrics and whether there was inappropriate prenotification. Methods: Retrospective audit of the stroke unit registry from July 2017 to February 2019. Patients notified by the ambulance service as having a suspected acute stroke using the screening tool (CRESST) [2] were identified. Time metrics for prenotified patients who received reperfusion therapies where compared to baseline local data, and inappropriate prenotification was determined from final diagnoses. Results: 799 patients were referred to the stroke service from the ED during the trial period. 82 patients had positive CRESST scores indicating possible stroke. Of these, 58 (70.73%) had a final diagnosis of stroke, of whom 40 (69.0%) had ischaemic stroke. Of these, 15 (37.5%) received reperfusion therapy. Compared to baseline data, prenotified patients received CT and thrombolysis, 2 and 15 minutes earlier, respectively. Prenotification resulted in a 32.5 minute time advantage compared to no stroke call and there was no increase in inappropriate prenotification. Discussion: While audited numbers are low, prenotification resulted in clear trend towards improved time metrics without an increase in inappropriate prenotification.