hospital and ems stroke care partnership: data collection ...€¦ · partnership: data collection,...
TRANSCRIPT
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Hospital and EMS Stroke Care
Partnership: Data Collection, Education
and Feedback
Peter Canning, Paramedic, R.N.
EMS Coordinator
UCONN Health/John Dempsey Hospital
NorthEast Cerebrovascular Consortium 10th Annual Conference
October 22, 2015
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Full-Time Paramedic in Hartford Since 1995
Part-time EMS Coordinator at UConn Since 2008
All-Time Zoey’s Dad
No Conflicts
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UCONN Health/John Dempsey Hospital
Primary Stroke Center (2014)
Farmington, Connecticut
• 174 Beds
• 30,000 ED Visits a year
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Stroke Modeled after STEMI Program
• STEMI Alert/Field
Activation
• Direct to CATH Lab
• Decreased D2B by 45%
• Mission Lifeline STEMI
Receiving Center Gold
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EMS Stroke Plan
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EMS Feedback for All Strokes and
Stroke Alerts (even if not a stroke)
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Collected Data Points
• Dispatched Lights and Sirens
• Response within 8 Minutes
• ALS Care
• Stroke Recognized
• Cincinnati Stroke Scale
• Blood Glucose
• On Scene 15 Minutes of Less
• Last Known Well Time
• Transported Lights and Sirens
• Stroke Alert
• Stroke Alert to CAT Scan
• TPA
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EMS Strokes (5 Quarters)
• 131 Strokes
109 Ischemic Strokes
22 Hemorrhagic Strokes
• 15 Received tPA (13.76% of Ischemic
strokes)
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Early Data (1st 35 Strokes)
EMS Recognized Stroke
• 95.4% Cincinnati Stroke Scale
• 95.4% Blood Glucose
• 100% Last Known Well Time Documented
• 95.4% Stroke Alerts
• 100% Stroke Alerts Direct to CT Scan
• 100% ALS Care
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EMS Radio Report- Sudden Confusion
Many strokes that did not have clear
Cincinnati Stroke Scale scores were being
missed.
Altered Mental Status
Focal Numbness
Fall
Dizzy with vomiting
Weakness
Vision Problems
Confusion
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Encouraged Possible Stroke Alerts
Stroke Imitators:
Seizure, Dehydration/UTI, Transient Global Amnesia, Complex Migraine, Posterior
Reversible Encephalopathy, Bell’s Palsy, Psychosis, Brain Tumor
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Review Dispatch Protocols
• Many possible strokes are sent “COLD” based on Emergency Medical Dispatch Protocols. If “Time is Brain,” these dispatch protocols need to be reviewed with each PSAP/EMD Center.
• Immediately met with local dispatch center, changed stroke response codes to HOT. Held later meetings with regional dispatch and did the same.
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TPA patients
• 100% Dispatched on Priority
• 60% Transported on Priority
• 93% Came in on Stroke Alerts/Direct to CT
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Recommendations
• Review Stroke Dispatch Protocols
• Educate Beyond Cincinnati Stroke Scale
• Encourage Priority Transport
• Direct to CT Scan with Stroke Alert
• Provide EMS Feedback
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?