Abstract Body: Background and Issues: Timely diagnosis and treatment are essential for optimal outcomes in acute stroke care. The lack of EMS integration into the stroke system of care is leading to delays in treatment resulting in poor outcomes. The absence of centralized resources at the Comprehensive Stroke Center (CSC) results in delayed patient care and worsened outcomes.
Purpose: This project aimed to enhance EMS stroke recognition and improve triage to appropriate stroke centers, thereby reducing treatment times. The successful integration of EMS with an optimized CSC triage protocol seeks to reduce hospital stays, mortality rates, direct costs, and long term disability.
Method: Effective integration of EMS into the stroke system of care was achieved by developing triage protocols with local EMS leaders. Adoption of a standardized stroke triage assessment tool was implemented. Centralizing resources at the CSC was a multidisciplinary approach to streamline the identification and treatment of stroke patients in a definitive location near CT scan. Stroke triage education and mock drills were provided to local EMS agencies and the acute stroke team. Outcomes were measured using pre and post intervention data for TNK administrations and endovascular therapy.
Results: Outcomes were measured in two groups of acute stroke patients who received TNK, mechanical thrombectomy, or both. 115 patients from 2022 prior to project initiation and 131 patients from 2023 after its initiation. TNK door-to-needle time decreased from 37 to 32 minutes. Thrombectomy door-to-revascularization time dropped from 118 to 85 minutes. Average hospital stay reduced from 8 to 7 days. Mortality rates fell from 13.04% to 3.94%. Direct costs decreased from $27,989 to $24,109. Thrombectomy mortality decreased from 17.14% to 6.06%. 90-day modified Rankin score 2 or less improved from 45% to 49%. Average EMS first contact to revascularization went from 152 minutes to 120 minutes. Average EMS first contact to TNK administration went from 70 minutes to 67 minutes.
Conclusion: The implementation of standardized EMS triage protocols and centralized resources at the CSC led to significant improvements in acute stroke care. The interventions resulted in faster treatment times, reduced hospital days, lower mortality rates, decrease in direct costs, and improved long-term functional outcomes. These findings highlight the significance of EMS integration and resource centralization to improve patient outcomes.