[Supply of emergency physicians for patients with stroke in the Münster area. A cross-sectional study of the quality of regional health care].

BACKGROUND AND OBJECTIVE

Advances in understanding the pathophysiology and treatment of stroke have led to changed requirements, including the prehospital phase, for the care of patients with acute stroke. Rapid transport to a regional stroke centre is nowadays considered to be the standard for optimal quality of care. A retrospective cross-sectional analysis was undertaken in 1996 in the region of the town of Münster to test the quality of medical care provided by physicians on emergency call.

PATIENTS AND METHODS

250 of 3001 protocols (8.3%) filled in by emergency call physicians were selected in which the initial diagnosis of transitory ischaemic attack, stroke or cerebral haemorrhage had been made. Quality of patient care was assessed according to the following criteria; (1) complete medical treatment (blood sugar, blood pressure, cardiac rhythm and arterial oxygen saturation, including relevant treatment of any abnormality) (2) action time (arrival of emergency doctor within 12 min and arrival at hospital within 50 min); (3) type of the admission hospital (stroke centre defined as a hospital experienced in the treatment of stroke, with neurological and medical departments, as well as 24-hour cover for computed cranial tomography). A summated indicator of "optimal care" was used to determine whether the three stated criteria were met.

RESULTS

Mean age of the stroke patients was 72.3 years. While the above mentioned quality criteria for the action time were met in 93.5% of patients, only 56.0% were admitted to a stroke centre, and this was significantly more often the final destination for patients under the age of 65 years than for older ones (p = 0.049). The quality indicator "complete medical treatment" was met for 27.2% of the transported patients. Measured according to present-day criteria, only 18.6% of patients received such optimal treatment.

CONCLUSION

This analysis indicates that modern prehospital treatment of stroke patients does not reach adequate standards. In particular, it is not comprehensive. While the "action time" is usually adequate, there are deficiencies regarding the quality of medical care and the choice of the admission hospital. Further education for emergency physicians with respect to the management of stroke syndrome should be an integral part of any regional quality programme. The number of hospitals with adequate competence in the acute management of stroke cases is still insufficient.