Optimizing handover in patients with stroke symptoms utilizing an organized protocol between emergency department providers and emergency medical personnel

Abstract

IntroductionStroke care is time sensitive. Providers in the emergency department (ED) depend on advanced notification from emergency medical services (EMS) transporting patients with stroke signs and symptoms. Barriers to EMS-ED information transfer can delay patient arrival preparation that may impact decisions, diagnosis, and time-sensitive transfer to next site of care. Information gaps or loss of information in the chain of care has been noted to contribute to possible safety threats for patients with stroke symptoms. MethodsThe aim of this project was to explore the feasibility of improving EMS-ED handover of patients with suspected stroke using a two-tiered checklist ranked in order of importance and a “time-out” upon EMS arrival to help standardize report, bridge the information gap, and promote earlier stroke management decisions. Paramedics from two local EMS agencies participated. Transmission and recorded report were measured before and after implementation followed by a satisfaction survey. Analysis also included a comparison group (control) of non-participating Fire Departments. ResultsOne hundred and sixty-eight potential stroke patients were transported to the ED during the 16-month intervention time frame. The pre and post intervention analysis of reported stroke symptoms showed statistically significant improvement in multiple checklist reporting areas. Noteworthy changes included improvement in reporting last time normal, current antiplatelet/anticoagulant, neurological deficits, baseline mental and functional status, medical history, code status, recent surgical history and family enroute. A post-survey demonstrated overall positive EMS-ED response to the new handover process. ConclusionThe feasibility of an EMS-ED standardized handover using a hierarchical (ranked in order of importance), two-tiered checklist and time-out process can effectively bridge the gap of communication between EMS and emergency providers to help promote timely hyperacute stroke care.