From the Department of Emergency Medicine, Michigan State University College of Human Medicine, Secchia Center, Grand Rapids (J.A.O.).
Kent County Emergency Medical Services, Grand Rapids, MI (T.C.).
Stroke. 2019 May;50(5):1193-1200. doi: 10.1161/STROKEAHA.118.023885.
Background and Purpose- Recognition of stroke symptoms and hospital prenotification by emergency medical services (EMS) facilitate rapid stroke treatment; however, one-third of patients with stroke are unrecognized by EMS. To promote stroke recognition and quality measure compliant prehospital stroke care, we deployed a 30-minute online EMS educational module coupled with a performance feedback system in a single Michigan county. Methods- During a 24-month study period, a registry of consecutive EMS-transported suspected or unrecognized stroke cases was utilized to perform an interrupted time series analysis of the impact of the EMS education and feedback intervention. For each agency, we compared EMS stroke recognition and quality measure compliance rates, as well as emergency department performance and hospital outcomes during 12 preintervention months with performance in the remaining study months. Results- A total of 1805 EMS-transported cases met inclusion criteria; 1235 (68.4%) of these had ischemic or hemorrhagic strokes or transient ischemic attacks. There were no trends toward improvement in any outcome before the intervention. After the intervention, the EMS stroke recognition rate increased from 63.8% to 69.5% ( P=0.037). Prenotification increased from 60.9% to 77.3% ( P<0.001). Among patients with ischemic stroke/transient ischemic attack, there was a trend toward higher rates of tPA (tissue-type plasminogen activator) delivery (13.9%-17.7%; P=0.096) and a significant increase in tPA delivery within 45 minutes (5.7%-8.9%; P=0.042) after intervention. However, improvements in EMS recognition were limited to the first 3 months following intervention. Conclusions- A brief educational intervention was associated with improved EMS stroke recognition, hospital prenotification, and faster tPA delivery. Gains were primarily observed immediately following education and were not sustained through provision of performance feedback to paramedics.
背景与目的- 急救医疗服务（EMS）识别中风症状并预先通知医院，有助于快速进行中风治疗；然而，三分之一的中风患者未被 EMS 识别。为了提高中风识别率和符合质量措施的院前中风护理，我们在密歇根州的一个县部署了一个 30 分钟的在线 EMS 教育模块，以及一个绩效反馈系统。
方法- 在 24 个月的研究期间，利用连续 EMS 转运的疑似或未识别中风病例登记，对 EMS 教育和反馈干预的影响进行了中断时间序列分析。对于每个机构，我们比较了 EMS 中风识别率和质量措施符合率，以及急诊室表现和医院结局，比较了干预前 12 个月和剩余研究期间的表现。
结果- 共有 1805 例 EMS 转运病例符合纳入标准；其中 1235 例（68.4%）患有缺血性或出血性中风或短暂性脑缺血发作。在干预前，任何结果都没有改善的趋势。干预后，EMS 中风识别率从 63.8%提高到 69.5%（P=0.037）。预先通知率从 60.9%提高到 77.3%（P<0.001）。在缺血性中风/短暂性脑缺血发作患者中，tPA（组织型纤溶酶原激活物）的使用率呈上升趋势（13.9%-17.7%；P=0.096），并且在干预后 45 分钟内 tPA 的使用率显著增加（5.7%-8.9%；P=0.042）。然而，EMS 识别率的提高仅限于干预后的前 3 个月。
结论- 简短的教育干预与提高 EMS 中风识别率、医院预先通知和更快的 tPA 给药有关。收益主要是在教育后立即观察到的，并且在向护理人员提供绩效反馈时没有持续。
