Best Practice:

Stroke Team Education –PreHospital: Decrease in Door to CT time.

Hospital: / Bassett Healthcare, Cooperstown, NY (Stroke module)
  • 203 beds
  • 15 stroke patients/month
  • Designated stroke center (though no designated stroke unit); hub for tele-stroke program
  • Serving 9 counties, 21 EMS units

Key Stakeholder / Trauma and Stroke Program Coordinator
Overview: / This hospital clearly benefits from the various roles that the Key stakeholder plays within the hospital (trauma as well as stroke coordinator) and within the EMS community (sits on the EMS council and is responsible for their stroke education).
Using the current trauma alert protocol as a model a stroke alert protocol was designed and implemented for EMS technicians. (a cardiac alert protocol was developed at about the same time).
This best practice benefits patients by providing early alert and critical onset information to the ED staff subsequently improving time to CT and labs.
Responsibilities: / EMS acts as the point of first contact for the ED, setting the stroke protocol in motion:
  • Alerts hospital of arriving stroke patient, which triggers ED stroke protocol (stroke team alerted; CT made ready).
  • Gathers preliminary data regarding stroke onset.

Implementation: / As the stroke and cardiac alert protocols mirror the previously existing trauma alert protocol the participant recalled it as an easy transition to implement.
Education: / Stroke education delivered twice yearly by ED physicians to EMS at monthly meetings (does not appear to be mandatory).
Tools developed: / Stroke education supplemented by reference tools:
  • Laminated reference cards for EMS
  • Information sheet for recording critical information (not part of permanent record as it has not been reviewed by forms committee)

Communication: / Communication with the various EMS personnel is relatively informal:
  • Informal email list
  • Also provide feedback on individual patients when asked; many EMS feel a personal connection to patients with an expressed interest in how “their” patient has fared

Impact: / Faster door to CT times with improved patient information:
  • Because EMS knows what the stroke team is looking for they are able to ask more questions, find out more / pertinent information from the patient’s family.

Advice: / Start by approaching whichever EMS most often comes to hospital, get on their agenda and make a request to join the “team.”
  • Present protocols and education at their level (not over their heads; talk to them, not at them)
  • Position as a cooperative venture to aid patients
  • Provide education that is worth their while, as most are volunteers