Abstract 2258: Ambulance Directed Care for Acute Stroke Patients at Cedars-Sinai Medical Center

Abstract

Quality Improvement Study: Background: Advances over the last decade highlight the important role of Emergency Medical Services (EMS) agencies in optimizing stroke care. Los Angeles County’s Department of Health Services (LA County DHS) Stroke Patient Policy was instituted on November 16, 2009. As a result, ambulances now transport suspected stroke patients directly to approved Stroke Centers. In a single institution-TJC certified as a PSC since 2008, we studied the effect of the Stroke Patient Destination Policy and ambulance-directed care on the percentage of ischemic stroke patients receiving acute stroke treatments (IV tPA, intra-arterial thrombolysis or clot-retrieval, or bridge therapy). Methods: 2, 156 patient charts were retrospectively reviewed from the 16 months prior to the implementation of ambulance-directed care compared to a 16-month period between after implementation of ambulance-directed stroke care. Results: In the pre-policy period, 344 suspected stroke patients arrived by EMS versus 491 suspected stroke patients arriving by EMS in the post-policy period - a 30% increase. (Chi 2 p=0.07). Of 344 patients, 34 (9.9%) received acute stroke treatment in the pre-policy period, compared to 63 of 491 patients receiving acute stroke treatments in the post-policy period (12.8%, NS). The median age of patients pre and post policy change was 69.5 years old. The median gender distribution was 46% male and 54% female. Neither age nor gender differed before or after the policy change. Conclusions: Implementation of the LA County DHS Stroke Patient Destination Policy appeared to cause a higher volume of acute stroke patients receiving treatment at one Joint Commission certified academic medical center. The data suggests that 29 additional patients were treated with acute stroke treatments due to ambulance directed care. Additional confirmatory data is needed from other centers.