Abstract T P246: Mode of Arrival for Acute Stroke Patients Directly Impacts Emergency Care Delivery

Abstract

Background: Tissue plasminogen activator (tPA) administration is very time sensitive with an odds ratio of a good outcome that is inversely proportional to time from onset to tPA administration. Extensive systems have been put in place to ensure rapid delivery of tPA in emergency medical systems, but little data exists evaluating the success of these systems for patients who arrive via Emergency Medical Services (EMS) vs. private vehicle. This study evaluates this issue using data from a single institution. Purpose: The purpose of this study is to gather data on process differences between acute stroke patients arriving via EMS vs. private vehicle and show how the data is utilized to identify areas for improvement in patient care delivery. Methods: Data was collected on 138 consecutive acute stroke patients, encompassing patient mode of arrival, as well as time to stroke alert activation, order entry, CT completion, lab results, and where applicable, telemedicine activation and tPA administration. This data was analyzed to evaluate for differences in performance of the stroke alert process based on mode of arrival. Results: Overall, the stroke alert process performed better for EMS patients than for patients arriving via private vehicle. Conclusions: Statistically significant differences were found between EMS and private vehicle arrival, with far better process performance seen for EMS patients. The delays in care occur initially in the activation of the stroke alert, then are continued throughout the process of care after the stroke alert has been called. In conclusion, recognition that processes do not perform equally in all situations is important in system design, and rigorous performance monitoring is paramount to ensure optimal care of all patients through performance improvement activities.