Abstract WP431: Comparing EMS and Emergency Department Last Known Well Times in Ohio

Abstract

Introduction: During the hyperacute phase of acute stroke management, time the patient was last known well (LKW) is a critical data element. Hospital Emergency Department (ED) personnel rely on accurate information reported by Emergency Medical Services (EMS) prior to arrival, which triggers the intensity of resources organized to determine patient eligibility for revascularization therapy. Over-triage can cause “alarm fatigue”, provider burnout, and/or overutilization of valuable resources. Conversely, under triage may cause a delay in, or lack of, revascularization therapy, which can have significant negative impact on the patient’s outcome. A review of the literature revealed contradictory data about the accuracy of LKW as reported by EMS. Purpose: The purpose of this project is to determine frequency and magnitude of discrepancies between LKW as reported by EMS and ED. The data was analyzed for trends that may influence discrepancies, such as hospital size, location, and patient demographics. Methods: Data on 2,092 patients from 49 hospitals was analyzed from Get With The Guidelines®-Stroke. The difference in the LKW (ΔLKW) was calculated based on source of documentation from EMS or ED. Three datasets were created based on the magnitude of the ΔLKW. For each dataset, the mean, median and patient demographics such as mean age, race, and stroke type were calculated. Results: Of 2,092 patients, 951 (45%) showed an exact match between LKW as reported by EMS and ED (ΔLKW=0), whereas 1,141 patients (55%) showed a discrepancy in the LKW (ΔLKW>0). Discrepancies were not influenced by hospital location or size. Of the overall population, 54% were male, 18% were black, and 73% were diagnosed with an ischemic stroke. The mean age was 72 years. Further collaboration is needed between EMS and ED personnel to improve the accuracy of LKW, and thereby improve patient care and provider efficiency.