Hospitals Often Not Alerted About Incoming Stroke Patients
TUESDAY July 10, 2012 -- Although prompt medical treatment is essential for people experiencing a stroke, hospitals aren't notified about incoming stroke patients in about one-third of cases, two new studies find.
The failure of emergency medical services (EMS) personnel to alert hospitals adds precious minutes on to how long it takes to diagnose stroke patients and administer clot-busting drugs, according to researchers.
Experts from the American Heart Association/American Stroke Association advised EMS to notify hospitals about incoming stroke patients so preparations can be made for their timely evaluation and treatment.
In the studies, researchers examined about 372,000 cases of acute ischemic stroke (caused by a blocked blood vessel to the brain) between 2003 and 2011. The patients were taken by ambulance to one of nearly 1,600 hospitals participating in a quality improvement program -- called "Get with The Guidelines-Stroke" -- launched by the heart/stroke associations.
One study, published in Circulation: Cardiovascular Quality & Outcomes, found that when EMS alerted hospitals about incoming stroke cases, the patients were diagnosed and treated more quickly.
Fast diagnosis and treatment is critical because certain clot-busting drugs have to be given within 3 to 4.5 hours after the onset of stroke symptoms to be effective, according to the study.
But a second study found that EMS pre-notification of stroke patients happened in only 67 percent of stroke cases in 2011, a slight increase from 2003 when hospitals were notified in about 58 percent of cases.
That study is published in the Journal of the American Heart Association.
"Despite national guidelines recommending pre-notification by EMS for acute stroke patients, it's disappointing that there's been little improvement," the senior author of both studies, Dr. Gregg C. Fonarow, a professor of cardiovascular medicine at the University of California, Los Angeles, said in an American Heart Association news release. "However, with these powerful new findings demonstrating substantial benefits with pre-notification, we have a tremendous opportunity to make positive changes in this component of stroke care."
For example, among patients who arrived at the hospital within two hours of experiencing symptoms, 83 percent with EMS pre-notification received the clot-busting drug tPA within the 3-hour window, compared to 79 percent without this advance notification. These patients also received imaging tests five minutes sooner and received clot-busting drugs two minutes faster once they got to the hospital.
Rates of hospital pre-notification varied widely -- from 93 percent in Montana to 20 percent in Washington, D.C., for example.
"The large variations by state and hospital are really striking and should be a concern because the potential for ideal patient care isn't being met," said Fonarow. "We've developed a map of rates by state. This tool can identify areas that are most in need of improved stroke care systems."
The researchers added that EMS pre-notification was much less likely among older or black patients. Rates were also lower among those with a history of stroke, diabetes or clogged leg arteries, a condition known as peripheral vascular disease.
This shows a need to target EMS education, concluded Fonarow. "These patients are at higher risk for stroke and other ailments and may present challenges to EMS determining in the field whether their symptoms represent stroke," he said. "The goal is that EMS provides advanced notification for every potential stroke patient being transported."
The U.S. National Institutes of Health provides more information on stroke.
Posted: July 2012
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