Educational Outreach Research Articles

Results of the CHlorhexidine Gluconate Bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections Study (CHanGing BathS): a stepped wedge cluster randomized trial

BackgroundCentral line-associated bloodstream infections (CLABSIs) result in approximately 28,000 deaths and approximately $2.3 billion in added costs to the U.S. healthcare system each year, and yet, many of these infections are preventable. At two large health systems in the southeast United States, CLABSIs continue to be an area of opportunity. Despite strong evidence for interventions to prevent CLABSI and reduce associated patient harm, such as use of chlorhexidine gluconate (CHG) bathing, the adoption of these interventions in practice is poor.The primary objective of this study was to assess the effect of a tailored, multifaceted implementation program on nursing staff’s compliance with the CHG bathing process and electronic health record (EHR) documentation in critically ill patients. The secondary objectives were to examine the (1) moderating effect of unit characteristics and cultural context, (2) intervention effect on nursing staff’s knowledge and perceptions of CHG bathing, and (3) intervention effect on CLABSI rates.MethodsA stepped wedged cluster-randomized design was used with units clustered into 4 sequences; each sequence consecutively began the intervention over the course of 4 months. The Grol and Wensing Model of Implementation helped guide selection of the implementation strategies, which included educational outreach visits and audit and feedback. Compliance with the appropriate CHG bathing process and daily CHG bathing documentation were assessed. Outcomes were assessed 12 months after the intervention to assess for sustainability.ResultsAmong the 14 clinical units participating, 8 were in a university hospital setting and 6 were in community hospital settings. CHG bathing process compliance and nursing staff’s knowledge and perceptions of CHG bathing significantly improved after the intervention (p = .009, p = .002, and p = .01, respectively). CHG bathing documentation compliance and CLABSI rates did not significantly improve; however, there was a clinically significant 27.4% decrease in CLABSI rates.ConclusionsUsing educational outreach visits and audit and feedback implementation strategies can improve adoption of evidence-based CHG bathing practices.Trial registrationClinicalTrials.gov, NCT03898115, Registered 28 March 2019.

Strategies to Approach Medicines Litigation: An Action Research Study in Brazil.

Background: In the last decades, litigation has been increasingly used to access medicines in Brazil. This phenomenon has led to the development of diverse strategies to reduce its negative impact on the organization of pharmaceutical services. In spite of that, managers still face difficulties dealing with lawsuits. Objective: This study aims to report the planning and implementation of strategies to approach medicines litigation in a municipality located in the southeast region of Brazil. Methods: Mixed methods were employed through an action research cycle. A network coordination team included researchers from university and municipal managers. The scenario analysis comprised the characterization of pharmaceutical services and the profile of medicines lawsuits. Afterward, strategies were planned to deal with the central problem identified. The action plan involved educational outreach visits and distribution of printed materials for health professionals, evaluated through opinion survey. Group conversations were conducted with the users of the public health system, followed by thematic analysis of reports. Results: The characterization of pharmaceutical services in the municipality revealed that treatments supplied were in accordance with the National Medicines Policy. In addition, a sector was implemented to attend demands for non-incorporated medicines. In spite of the services available, the characterization of lawsuits indicated that the main claimants were users of the public health system, requiring non-incorporated medicines, with therapeutic alternatives available. Thus, educational outreach visits were held in 14 health units (23 physicians in total). Everyone who answered the evaluation declared that they were very satisfied with the approach. Group conversations with the users of the health system reached 227 participants in total. In regard to users’ perception about pharmaceutical services, thematic analysis of reports identified three main categories including aspects related to medicines provided, users assisted, and quality of service. Conclusion: The study described the first cycle of an action research project to develop strategies to approach medicines litigation at the municipal level. The application of educational outreach visits for health professionals and group conversations with health system users is a promising approach to improve access to information about pharmaceutical services in Brazil.

Place-based motivations and normative beliefs predict pro-environmental behavior across involvement profiles

Understanding the relationships among social psychological drivers of pro-environmental behavior has been the focus of a long-standing body of research aimed at minimizing human impacts on the environment. Within public land management contexts, empirical evidence has suggested that place-based motivations and normative beliefs explain why people intend to engage in behavior that benefits the environment; however, the personal relevance of outdoor activities varies, in that recreationists often report distinct degrees of involvement that influence patterns of thought and behavior. Therefore, we tested the moderating effect of enduring involvement in outdoor recreation on the relationships among motivations, normative beliefs, and pro-environmental behaviors that reflected tenets of the Leave No Trace (LNT) educational outreach program. We segmented respondents into involvement profiles and tested a series of hypothesized relationships using multi-group structural equation modeling. Data were derived from a study of white water rafters on the Kern Wild and Scenic River in California's Sierra Nevada. Results indicated that both the strength and influence of select motivations on normative beliefs are stronger among individuals with higher involvement in rafting. A relationship between respondents' stated levels of importance for achievement as a motive for activity participation and normative beliefs about LNT also emerged among respondents with medium levels of involvement, whereas normative beliefs about LNT are associated with place-based motives for being with similar people and being in nature among those with high levels of involvement. These results explain the relationships among multiple antecedents of behavior within the context of a high-risk wilderness experience. The behavioral phenomena examined in this research explain the development of stewardship practices to help sustain environments while optimizing visitor experiences in the outdoors.Natural resource recreation managers should consider the personal relevance of activities as defining features that explain variation in motivations and responses to normative pressure. The presented results indicate that framing information in line with the involvement profiles will be more likely to resonate with recreationists in related contexts. Respondents were motivated to engage in white water rafting to be around similar people, enjoy nature, learn, and escape from personal and social pressures, but these motivations vary in accordance with levels of involvement. In settings where recreationists are presented with opportunities to engage in nature-based recreation that requires specialized skills, those with high levels of involvement may be more sensitive to normative pressures to protect the expected outcomes of their nature-based goals and desire to be around other highly involved recreationists.

Current management of button battery injuries.

Button batteries (BB) are found in common household items and can lead to significant morbidity and mortality in the pediatric population when ingested. BBs are made of various chemistries and have a unique size and shape that yield significant injury when lodged in the pediatric esophagus. BBs create a local tissue pH environment of 10 to 13 and can induce liquefactive necrosis at the negative pole. This initial injury can progress with further tissue breakdown even after removal. Unfortunately, patients may present with vague symptoms similar to viral illnesses and there is not always a known history of ingestion. Plain film X‐ray can be diagnostic. Exposure can lead to caustic injury within 2 hours. Thus, timely endoscopic removal is the mainstay of treatment. Novel mitigation and neutralization strategies have been implemented into treatment guidelines. These include the preremoval ingestion of honey or sucralfate and intraoperative irrigation with acetic acid. Depending on the severity of injury following removal, careful consideration should be given for potential delayed complications including fistulization into major vessels which often leads to death. The National Button Battery Taskforce and several industry members have implemented prevention strategies such as educational safety outreach campaigns, child‐resistant packaging changes, and warning labels. Governmental regulation and industry changes are key to limit not only the amount of BB ingestions, but also the devastating consequences that can result. Anonymous reporting of BB injuries through the Global Injury Research Collaborative has been made convenient and centralized through the advent of a user‐friendly smartphone iOS/App Store and Android/GooglePlay application called the “GIRC App”; all specialists who manage foreign body cases should contribute their cases to help prevent future injuries. BB ingestion must be recognized and treated promptly using a multidisciplinary approach to optimize outcomes for these patients. Ultimately, a safer BB technology is critically needed to reduce or eliminate the severe and life‐threatening injuries in children.Level of Evidence5

Free tuition plan helps close equity gaps

“I've seen the gaps in access to education,” said B. Donta Truss, Vice President for Enrollment Development and Educational Outreach at Grand Valley State University. Truss began his current role at GVSU in July 2020 and helped launch the university's free tuition program, the Grand Valley Pledge.

Human-wildlife conflict mitigation and the self-efficacy of wildlife professionals in non-formal education and outreach

ABSTRACT Preventing human-wildlife conflict (HWC) constitutes a substantial challenge for wildlife agencies. The literature on HWC is primarily focused on public understanding of and perceptions toward HWC issues and on mitigation interventions, which often involve public education and outreach. Yet, the non-formal education and community outreach capacities of wildlife professionals remain relatively under-studied. This study develops new insights into the professional development (PD) needs of wildlife professionals relevant to non-formal education and community outreach aimed at mitigating HWC. Using data generated through a self-administered questionnaire designed to assess the self-efficacy of respondents in non-formal education and community outreach skill areas, this study proposes a PD sequence that prioritizes the relevant HWC training needs of a sample of wildlife professionals from the Four Corners region of the United States. The sequence spans curriculum development, media engagement, and evaluation. Recommendations for practice and future research are provided.

Memory, Responsibility, and Transformation: Antiracist Pedagogy, Holocaust Education, and Community Outreach in Transatlantic Perspective

ABSTRACT The ‘Unite the Right’ rally on 11 and 12 August 2017, shook the city of Charlottesville, Virginia, and spurred a national conversation about the long history of racial oppression in the United States and the future of its democracy. This article reviews the Transatlantic Partnership on Memory, Responsibility and Transformation, a collaboration between the Heinrich Böll Foundation North America and the Center for German Studies at the University of Virginia. Launched in response to the violent rally on the university's grounds and in downtown Charlottesville, the partnership adds a transnational dimension to antiracist pedagogy and Holocaust education. Through interdisciplinary projects, it challenges students to translate classroom learnings into hands-on practice of participatory democratic citizenship in local communities. The partnership's aim is to situate the study of memory and history in contemporary discussions of racial justice and responsible citizenship and to animate students to find urgency and relevance in the specific lessons of the Holocaust and in broader, transnational legacies of systemic oppressions. Starting with a discussion of the initiative's origins in the aftermath of far-right violence, this article offers some of the lessons learned through the partnership, as well as recommendations for others who might wish to explore similar pedagogical practices and programing.

Culture of prevention and early disease detection of cancer in Russia

This study analyzed the early cancer detection in Russia. Using data from the Russian Ministry of Health from 2005 to 2016, this study aims to evaluate relationships between the number of patients diagnosed with I-II stage of cancer with the number of preventive visits, screening tests, and expedited access to specialists. The results of de-trending time-series model indicate that the number of specialists in outpatient facilities and the number of patients' preventive visits positively affect the number of patients diagnosed with cancer for the first time and the number of patients diagnosed with I-II degree cancer. The Russian Federation's experience suggests that early detection of cancer can be achieved by increasing the number of early cancer screening facilities, providing free screening, and moderating geographical and time constraints that prevent people of different geographic and socio-economic backgrounds from being screened. Another strategy includes dispelling myths associated with cancer screening, fostering outreach and patient education, and assuring availability and timely referrals to specialists and laboratory work.

Flood Hazard Awareness at Old Dominion University: Assessment and Opportunity

AbstractBuilding resilience to flooding is a commitment of several universities; however, student interest in flood education programs is unclear. The goals of this research are three‐fold: 1) to determine the origin of flood messaging on the Old Dominion University (ODU) campus, 2) to assess on‐campus flood awareness, and 3) to evaluate the interest in additional flood education. This study evaluates student awareness of flooding via a survey of ODU students and contextual analysis of University warning messages. Many students experienced reduced access to campus as a result of flooding and expressed an interest in additional flood information. Some students reported receiving flood‐related information through in‐class instruction or orientation‐based programming. However, the content varies in detail, and ODU could formally integrate additional resources into outreach and flood education programming. These findings could support the development of a campus wide flood awareness program at ODU and other universities.

599 A Retrospective Outcome Analysis of the Involvement of Department of Child Services in Suspected Cases at a Major Regional Pediatric Burn Center

Abstract Introduction Cases of child abuse are an important manifestation of pediatric burns owing to their nature and all too common occurrence. In our institution, the Department of Child Services (DCS) is often frequently involved in minimally suspicious cases in conjunction with or even before the internal child protective team involvement. To our knowledge, there is no recent literature evaluating the outcome of DCS involvement in suspected cases in pediatric burn populations. Methods We performed a retrospective chart analysis of the pediatric burn patient database at our institution from 2017–2020. We identified 116 out of 565 patients who matched our criteria for the involvement of DCS. We collected the following information: age, race, address at time of injury, payer source, where DCS involvement was initiated, and the outcome of the investigation. Results We found that 20.5 % of all the pediatric burn patients admitted from 2017–2020 had DCS involvement. Of the total admitted patients only 3.8% were removed from the previous caregivers. The factors that were found to be statistically significant were male sex, age under 3 years, Caucasian child with single parent and living in an urban setting. A higher incidence was noted in the capital city area compared to the rest of the state. There was no statistical difference noted among races, location of DCS notification, and payer source. Conclusions We conclude that vigilance and early reporting is essential in detecting child abuse. Involvement of the multidisciplinary child protection team at our institution may reduce the burden on DCS. Screening out high risk factors such as age less than 3 years old, male sex, and single parent of Caucasian race may assist in detecting the non-accidental burn victims. We will target prevention educational outreach programs to the community to decrease the occurrence of child abuse in the future.

Improving Pneumococcal Vaccination Rates among Rural Older Adults through Academic Detailing: Medicine, Nursing and Pharmacy Partnership.

Academic detailing is an educational approach involving provision of evidence-based information by healthcare providers for healthcare providers with the goal of improving clinical decision-making. An interprofessional academic detailing initiative was developed to encourage rural providers to utilize guidelines when deciding which patients to vaccinate against pneumonia. This study utilized a quasi-experimental, single-group, pre-post observational design with physicians, nurses, and staff at two rural medical clinics. The 12-month academic detailing intervention included a needs assessment, workflow assessment of practice-based health information technology, vaccination training for providers and staff, and creation of exam-room posters encouraging patients to discuss vaccination with their provider. Six visits were made to deliver education, discuss needs, select priorities, and develop action plans from recommendations. Data were collected from each site for three years prior to the intervention year and for one year following the intervention. The annual rate of patients vaccinated increased during the five-year study. The cumulative proportion of the sample population that received vaccination also increased over time. Interprofessional academic detailing was well received and increased pneumococcal vaccination rates among rural-dwelling older adults. Given the alarming disparities in health outcomes for rural patients, educational outreach is needed to improve healthcare access and outcomes.

COVID-19 and Gaza: The Ideal Time to Establish a Medical Reserve Corps of Public Health Preventive Medicine Specialists.

COVID-19 and Gaza: The Ideal Time to Establish a Medical Reserve Corps of Public Health Preventive Medicine Specialists.

Evaluation of an Educational Outreach Campaign (IMPACT) on Pain Management Delivered to General Practices in Walsall

Abstract Introduction Opioid class drugs are a commonly prescribed form of analgesic widely used in the treatment of acute, cancer and chronic non-cancer pain. Up to 90% of individuals presenting to pain centres receive opioids, with doctors in the UK prescribing more and stronger opioids (1). Concern is increasing that patients with chronic pain are inappropriately being moved up the WHO ‘analgesic ladder’, originally developed for cancer pain, without considering alternatives to medications, (2). UK guidelines on chronic non-cancer pain management recommend weak opioids as a second-line treatment, when the first-line non-steroidal anti-inflammatory drugs / paracetamol) ineffective, and for short-term use only. A UK educational outreach programme by the name IMPACT (Improving Medicines and Polypharmacy Appropriateness Clinical Tool) was conducted on pain management. This research evaluated the IMPACT campaign, analysing the educational impact on the prescribing of morphine, tramadol and other high-cost opioids, in the Walsall CCG. Methods Standardised training material was delivered to 50 practices between December 2018 and June 2019 by IMPACT pharmacists. The training included a presentation on pain control, including dissemination of local and national guidelines, management of neuropathic, low back pain and sciatica as well as advice for prescribers on prescribing opioids in long-term pain, with the evidence-base. Prescribing trends in primary care were also covered in the training, and clinicians were provided with resources to use in their practice. Data analysis included reviewing prescribing data and evaluating the educational intervention using feedback from participants gathered via anonymous questionnaires administered at the end of the training. Prescribing data analysis was conducted by Keele University’s Medicines Management team via the ePACT 2 system covering October 2018 to September 2019 (two months before and three months after the intervention) were presented onto graphs to form comparisons in prescribing trends of the Midland CCG compared to England. Results Questionnaires completed at the end of sessions showed high levels of satisfaction, with feedback indicating that participants found the session well presented, successful at highlighting key messages, and effective in using evidence-based practice. 88% of participants agreed the IMPACT campaign increased their understanding of the management and assessment of pain, and prescribing of opioids and other resources available to prescribers. The majority (85%) wished to see this form of education being repeated regularly in the future for other therapeutic areas. Analysis of the prescribing data demonstrated that the total volume of opioid analgesics decreased by 1.7% post-intervention in the Midlands CCG in response to the pharmacist-led educational intervention. As supported by literature, the use of educational strategies, including material dissemination and reminders as well as group educational outreach was effective in engaging clinicians, as demonstrated by the reduction in opioid prescribing and high GP satisfaction in this campaign. Conclusion The IMPACT campaign was effective at disseminating pain-specific guidelines for opioid prescribing to clinicians, leading to a decrease in overall prescribing of opioid analgesics. Educational outreach as an approach is practical and a valuable means to improve prescribing by continuing medical education.

Prostate Cancer: Community Education and Disparities in Diagnosis and Treatment.

Prostate cancer remains the leading diagnosed cancer and the second leading cause of death among American men. Despite improvements in screening modalities, diagnostics, and treatment, disparities exist among Black men in this country. The primary objective of this systematic review is to describe the reported disparities in screening, diagnostics, and treatments as well as efforts to alleviate these disparities through community and educational outreach efforts. Critical review took place of retrospective, prospective, and socially descriptive data of English language publications in the PubMed database. Despite more advanced presentation, lower rates of screening and diagnostic procedures, and low rates of trial inclusion, subanalyses have shown that various modalities of therapy are quite effective in Black populations. Moreover, patients treated on prospective clinical trials and within equal-access care environments have shown similar outcomes regardless of race. Additional prospective studies and enhanced participation in screening, diagnostic and genetic testing, clinical trials, and community-based educational endeavors are important to ensure equitable progress in prostate cancer for all patients. IMPLICATIONS FOR PRACTICE: Notable progress has been made with therapeutic advances for prostate cancer, but racial disparities continue to exist. Differing rates in screening and utility in diagnostic procedures play a role in these disparities. Black patients often present with more advanced disease, higher prostate-specific antigen, and other adverse factors, but outcomes can be attenuated in trials or in equal-access care environments. Recent data have shown that multiple modalities of therapy are quite effective in Black populations. Novel and bold hypotheses to increase inclusion in clinical trial, enhance decentralized trial efforts, and enact successful models of patient navigation and community partnership are vital to ensure continued progress in prostate cancer disparities.

Pattern of human dhole interaction in buffer area of Jigme Khesar Strict Nature Reserve

Human-wildlife conflict is a serious problem to conservation efforts worldwide. This is also true for Bhutan, where carnivores depredate livestock of farmers, affecting farmer’s livelihood, however, there is sparse documentation on the extent of human dhole interaction in Bhutan’s some of the important areas of conservation interest. Therefore the aim of this research was to evaluate the extent of human dhole interaction, income lost due to depredation and the perception of the farmers towards dhole conservation. Data were collected from 160 households within two strata of rural and semi-urban area in western Bhutan through semi-structured questionnaire and focused group discussions. Livestock depredation involved seven predators, which caused loss of 5% of the total average annual income of the farmers; which were significantly different between the predators involved. Dhole killed significantly more livestock than other predators and maximum kills were made in rural area than semi urban area. 60% of the incomes lost due to wild predators were caused by dhole with major impact in rural area. Majority of the respondents from rural area exhibited negative attitude towards dhole conservation. They suggested livestock depredation compensation schemes and other livelihood alternatives to minimize the impact of conflict, whereas majority of the respondents from semi-urban suggested electric fencing around their village as measures to reduce human wildlife conflict. Livestock compensation and insurance schemes, integrated conservation development programs, educational outreach programs with other livelihood alternatives such as ecotourism are recommended as intervention strategies to minimize human dhole conflict and create harmonic co-existence.

Predicting Age Groups of Reddit Users Based on Posting Behavior and Metadata: Classification Model Development and Validation.

BackgroundSocial media are important for monitoring perceptions of public health issues and for educating target audiences about health; however, limited information about the demographics of social media users makes it challenging to identify conversations among target audiences and limits how well social media can be used for public health surveillance and education outreach efforts. Certain social media platforms provide demographic information on followers of a user account, if given, but they are not always disclosed, and researchers have developed machine learning algorithms to predict social media users’ demographic characteristics, mainly for Twitter. To date, there has been limited research on predicting the demographic characteristics of Reddit users.ObjectiveWe aimed to develop a machine learning algorithm that predicts the age segment of Reddit users, as either adolescents or adults, based on publicly available data.MethodsThis study was conducted between January and September 2020 using publicly available Reddit posts as input data. We manually labeled Reddit users’ age by identifying and reviewing public posts in which Reddit users self-reported their age. We then collected sample posts, comments, and metadata for the labeled user accounts and created variables to capture linguistic patterns, posting behavior, and account details that would distinguish the adolescent age group (aged 13 to 20 years) from the adult age group (aged 21 to 54 years). We split the data into training (n=1660) and test sets (n=415) and performed 5-fold cross validation on the training set to select hyperparameters and perform feature selection. We ran multiple classification algorithms and tested the performance of the models (precision, recall, F1 score) in predicting the age segments of the users in the labeled data. To evaluate associations between each feature and the outcome, we calculated means and confidence intervals and compared the two age groups, with 2-sample t tests, for each transformed model feature.ResultsThe gradient boosted trees classifier performed the best, with an F1 score of 0.78. The test set precision and recall scores were 0.79 and 0.89, respectively, for the adolescent group (n=254) and 0.78 and 0.63, respectively, for the adult group (n=161). The most important feature in the model was the number of sentences per comment (permutation score: mean 0.100, SD 0.004). Members of the adolescent age group tended to have created accounts more recently, have higher proportions of submissions and comments in the r/teenagers subreddit, and post more in subreddits with higher subscriber counts than those in the adult group.ConclusionsWe created a Reddit age prediction algorithm with competitive accuracy using publicly available data, suggesting machine learning methods can help public health agencies identify age-related target audiences on Reddit. Our results also suggest that there are characteristics of Reddit users’ posting behavior, linguistic patterns, and account features that distinguish adolescents from adults.

Diagnostic Walkabouts: Seventeen Years of Specialized Training for Horticultural Professionals

A diagnostic walkabout (DW) is an in-field diagnostic training program for professionals in the green industry (greenhouse, landscape, nursery, and turf businesses). DWs have been scheduled annually since 2002 and are easily replicable, fee-based programs that provide cost recovery. DWs also serve as a mentoring program for new Extension educators. Four generations of Extension Educators have participated. Recently, the annual program has been sponsored by state and regional trade associations. What began as an educational outreach program has become a bridge spanning Extension, trade associations, businesses, and generations of Extension educators.

Efektivitas Pilkada Serentak Tahun 2020 di Tengah Pandemi Covid-19 Indonesia

This study examines effectiveness 2020 simultaneous regional elections in the midst of Covid-19 pandemic. In addition, indicators of success Pilkada are integrity organizers and public participation in exercising their voting rights. Therefore, looking at 2020 Pilkada which was held in midst Covid-19 pandemic is still an important discourse. This study used descriptive qualitative method. Data collection techniques use primary data obtained from webinars on local political democracy during pandemic and secondary data by citing books, journals, documents and printed media, as well as other supporting materials. The results showed that the 9 December 2020 Pilkada had several threats and opportunities, including; First, threat of high number of positive cases of Covid-19, limited time, process updating voter data, technical guidance for ad hoc administrators, logistical budgets, education and political outreach. Second, opportunities for technology and information as means of political education and political socialization. Third, organizing regional elections by using e-voting, being the right recommendation, seeing use of e-voting can preserve people's voting rights and inhibit spread of Covid-19.

Recent HIV testing and associated factors among people who use drugs in Cambodia: a national cross-sectional study

ObjectiveTo estimate the prevalence of HIV testing and examine factors associated with recent HIV testing among people who use drugs (PWUD) in Cambodia.DesignCross-sectional study.SettingTwelve major provinces with a high burden...

Abstract P286: The Effects of COVID-19 on the Reasons for Not Calling 911 for Acute Stroke

Objective: Our Stroke Program regularly provides community outreach and stroke education. The stroke team educates on signs and symptoms of stroke, risks factors, and 911 activation. Within a few days of discharge, Neuroscience nurses call stroke patients to ensure patients have obtained their prescription medications, have follow-up appointments, inquire about their satisfaction with our services, and reinforce stroke education. As part of these calls, our team asked why patients/families did not call 911. The purpose of this study was to determine if the COVID-19 crisis influenced the reasons why 911 was not called for possible stroke to better plan for targeted stroke education. Method: Discharge phone survey data from our stroke network was collected from Feb-Jul 2019 and compared to Feb-Jul 2020. Our stroke network includes 1 comprehensive stroke center and 2 primary stroke centers. Emergency Department (ED) stroke activation data was gathered for the same time periods. Discharge phone calls data was based on discharge date, whereas ED stroke alert data was based on admission date. Results: There was a notable decline in stroke volume between 2019 to 2020 with the largest decline occurring during the first peak (Apr 2020) in COVID-19 cases within our state. This decline was driven by a 16% decline in walk-in ED stroke arrivals as compared to a 1% decline in EMS stroke arrivals. Of those who did not call 911 in 2020, there was a 7% increase in failing to recognize stroke symptoms as an emergency, a 6% increase in concern about EMS cost, and 6% decrease in hospital preference. Conclusion: The COVID-19 crisis negatively influenced stroke volumes within our system stroke program. Reductions in stroke walk-ins accounted for this decline. COVID-19 affected the reasons why 911 was not called. The largest increase was in not recognizing stroke symptoms as an emergency and increased concern about EMS associated costs. Surprisingly, COVID-19 was not listed as a reasons for avoiding 911. Targeted community educational efforts on these concerns may lead to improved 911 usage for suspected stroke during the COVID-19 pandemic. Limitations: Further research is needed to investigate why those with a stroke who would have been walk-ins decided not to seek urgent medical attention.