“Some things you can do well or do quickly. Often in medicine you need to do both.”

ED Sign

Just got out of the monthly meeting looking at our prehospital stroke code program. We are now three months into this pilot program designed to speed patients directly to CT from the field with lab work already drawn. The goal is to reduce Door to TPA time by shortening time to CT and lab results. We set an ambitious goal of deciding go\no-go in terms of TPA within 30 minutes of arrival.

Using the Cincinnati Stroke Scale our paramedics identify potential stroke patients and expedite their care by inserting two peripheral IVs, obtaining needed blood specimen, and recording as much history of present illness that is available from the patient and relatives\bystanders. Upon arrival in ED these patients bypass an ED bed and go directly to CT scanner. The handoff is then made during the process of obtaining a noncontrast CT of head and while the blood specimens are sent off for analysis.

For January:

  • We had 18 prehospital stroke codes (PSC) out of 40 total stroke codes (SC).
  • 100% of those PSC met the national goal of CT within 20 minutes of arrival (vs less than 40% of non-PSC).
  • The 3 PSCs who received TPA did so at signficantly shorter intervals than the non-PSC patients.
  • The paramedics have high sensitivity and specificity in terms of PSCs being diagnosed as strokes\TIAs (few misses or over calls).
  • Quality of prehospital blood specimens and appropriate labeling is approaching targets of no defects.

This program has had a great impact on the roughly half of our stroke code patients who arrive via our hospital’s paramedic units. However it has no impact on those that arrive via private vehicles or via paramedic units outside of our system. To address these needs follow up planning includes:

  • Inviting other paramedic units in the region to join this process.
  • Develop a similar in-department process for those identified at registration\abbreviated triage.
  • Expanding this to include prehospital patients with Acute MIs to increase cardiac cath lab activation prior to arrival. 
standing out

Like all great initiatives this one requires the hard work of many links in the chain. This includes the entire ED staff along with our paramedics and our colleagues in the lab and radiology.