Abstract WP253: Effect Of A Feedback System Of The Formal Diagnosis After Admission On The Emergency Medical Service
Background and Purpose: Accurate identification of patients with stroke by emergency medical service (EMS) staffs may shorten prehospital delay. We produced an original stroke check sheet with a total 24 items, including vital signs, past history, Cincinnati prehospital stroke scale (PSS), Kurashiki PSS, and provisional diagnosis of stroke subtypes by EMS staffs. We started to feedback the final diagnosis of each patient 2 to 3 weeks after admission to our institute from June, 2011. The aim of this study was to verify effects of this feedback system on the EMS.
Methods: We retrospectively enrolled 4,013 patients who were admitted to our hospital by using EMS from January, 2010 to March, 2012. We started the diagnosis feedback system to EMS from June, 2011. We divided the patients into 2 groups; those being admitted from January, 2010 to May, 2011 (group A) and those from June, 2011 to March, 2012 (group B). We compared positive predictive value (PPV) of provisional stroke diagnosis and the proportion of patients conveyed within 3 hours after the symptom onset between the 2 groups.
Results: We collected a total of 2,130 stroke check sheets from conveyed patients; 1,280 in the group A and 850 in the group B. The number of patients with a final diagnosis of stroke was 904 in the group A and 621 in the group B. The number of patients with a provisional diagnosis of stroke at the time of conveyance was 629 in the group A and 406 in the group B. The PPV of a provisional diagnosis of stroke by EMS staff was not different between the 2 groups; 70% in the group A vs. 65% in the group B. Proportion of conveyance within 3 hours after the symptom onset in the group B was as the same level as that in the group A (57% vs. 57%, p=0.964).
Conclusion: We started to feedback the final diagnosis of each patient 2 to 3 weeks after admission. The improvement was not accepted by the PPV of stroke and the proportion of conveyance within 3 hours after the symptom onset. Our feedback system of the final diagnosis to the EMS has to be improved.
- © 2012 by American Heart Association, Inc.