Abstract 195: Beneficial Impact of EMS Routing to Certified Stroke Centers on Door to Imaging Times
Background Effective acute interventions for ischemic and hemorrhagic stroke are time-critical, making rapid brain imaging an important component of high quality stroke care. National guideline recommendations are that initial brain imaging be performed within 25 minutes of ED arrival. Direct EMS routing of acute stroke patients to certified Stroke Centers has the potential to increase the proportion of patients receiving high quality care, including more rapid post arrival brain imaging.
Methods Data collected in the ongoing, region-wide NIH FAST-MAG trial permitted analysis of the impact of EMS implementation of a stroke center routing policy on door to imaging (DTI) times. FAST-MAG is an NIH, multicenter trial of prehospital initiation of neuroprotective therapy conducted in 228 ambulances transporting patients to 51 adult receiving hospitals in Los Angeles County. In November 2009, the LA EMS Agency instituted a policy of preferentially routing acute stroke patients to Approved Stroke Centers that had been certified by the Joint Commission. Data on patients from all sites was analyzed from 2005-2010.
Results Among the first 1000 patients enrolled, mean age was 70 (SD 14), 41%were female, median NIHSS was 9 (IQR 3, 17) and onset to door time was 71 (SD 55) minutes. Throughout the 5 year period analyzed, patients cared for at hospitals that would become Approved Stroke Centers (ASCs) had shorter door to imaging times than patients cared for at non-ASCs. Comparing the 9 inaugural ASCs with the 42 others, 34.4 vs 42.3 minutes (0.001). Comparing the 23 eventual ASCs with the 28 non-ASCs, 35.5 vs 46.5 minutes (<0.0001). Preferential EMS routing of patients to ASCs resulted in a reduction of DTI times among the entire cohort: enrollments across all sites before vs after implementation of the routing policy: 44.9 vs 32.0 minutes (<0.0001). With implementation of the routing system, the proportion of patients meeting the 25 minute DTI goal increased from 25% vs 47%, p<0.0001.
Conclusions Direct EMS routing to certified Stroke Centers reduced times from ED arrival to initial brain imaging, and more than doubled frequency of achievement of the national DTI target. These results support wide national dissemination of regionally organized stroke critical care systems.
- © 2012 by American Heart Association, Inc.