Abstract TP320: Different Response Times to Intrahospital Stroke Between Medical and Surgical Infirmaries: A Dunning-Kruger Effect?

Abstract

Rapid response teams (RRT) improve speed and quality of urgent inpatient care. Nonetheless, its effectiveness depends on adequate problem identification and fast triggering of institutional procedures. Differences in patient profiles and team experience between medical (Me) or surgical (Su) wards may influence the response times to suspected intrahospital strokes. From January/2016 through April/2019, we retrospectively analyzed data in a large tertiary hospital in Brazil. There were proportionally more callings for suspected strokes in medical wards (36/281 [13%] Me vs. 16/619 [2%] Su, p<0.001) in relation to the total of calls for any reason, while the ratio of diagnostic confirmation was similar (19/36 [52%] Me vs. 10/16 [62%] Su, p=0.495). Ischemic strokes were more prevalent in both infirmaries (17/19 [89%] Me vs. 8/10 [80%] Su, p=0.43). While not statistically significant, there were numerical differences between time to symptom recognition and the interval between recognition and triggering of the RRT. Medical ward teams recognized symptoms on average 108 minutes after the presumed onset versus 164 minutes in surgical wards. Paradoxically, surgical teams more promptly called RRT after recognition, on average 93 versus 172 minutes. There were no statistical differences in the ratio of ischemic strokes submitted to intravenous thrombolysis (11/17 [35,3%] Me vs. 1/8 [12,5%] Su, p=0.25) or mechanical thrombectomy (2/17 [11,8%] Me vs. 0/8 Su, p=0.45), however it is possible that the small number of events (52 calls in 40 months) led to low statistical power. This study suggests there may be differences in initial responses to suspected intrahospital strokes between different ward profiles. These might be secondary to variations in patient characteristics and team education, but also be caused by a Dunning-Kruger phenomenon (i.e. a higher perception of knowledge on stroke care leading to delays in triggering institutional workflows). Identifying these divergences in further larger, prospective trials can help develop individualized interventions to improve the quality of care in these medical emergencies.