Prevalence and predictors of hospital prealerting in acute stroke: a mixed methods study
Sheppard, James P. Lindenmeyer, A. Mellor, Ruth M. Greenfield, Sheila Mant, Jonathan Quinn, Tom Rosser, Andrew Sandler, David Sims, D. Ward, Matthew
Sheppard, James P.
Lindenmeyer, A.
Mellor, Ruth M.
Greenfield, Sheila
Mant, Jonathan
Quinn, Tom
Rosser, Andrew
Sandler, David
Sims, D.
Ward, Matthew
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Abstract
Background Thrombolysis can significantly reduce the
burden of stroke but the time window for safe and
effective treatment is short. In patients travelling to
hospital via ambulance, the sending of a ‘prealert’
message can significantly improve the timeliness of
treatment.
Objective Examine the prevalence of hospital
prealerting, the extent to which prealert protocols are
followed and what factors influence emergency medical
services (EMS) staff’s decision to send a prealert.
Methods Cohort study of patients admitted to two
acute stroke units in West Midlands (UK) hospitals using
linked data from hospital and EMS records. A logistic
regression model examined the association between
prealert eligibility and whether a prealert message was
sent. In semistructured interviews, EMS staff were asked
about their experiences of patients with suspected
stroke.
Results Of the 539 patients eligible for this study,
271 (51%) were recruited. Of these, only 79 (29%)
were eligible for prealerting according to criteria set out
in local protocols but 143 (53%) were prealerted.
Increasing number of Face, Arm, Speech Test symptoms
(1 symptom, OR 6.14, 95% CI 2.06 to 18.30, p=0.001;
2 symptoms, OR 31.36, 95% CI 9.91 to 99.24,
p<0.001; 3 symptoms, OR 75.84, 95% CI 24.68 to
233.03, p<0.001) and EMS contact within 5 h of
symptom onset (OR 2.99, 95% CI 1.37 to 6.50
p=0.006) were key predictors of prealerting but eligibility
for prealert as a whole was not (OR 1.92, 95% CI 0.85
to 4.34 p=0.12). In qualitative interviews, EMS staff
displayed varying understanding of prealert protocols
and described frustration when their interpretation of the
prealert criteria was not shared by ED staff.
Conclusions Up to half of the patients presenting with
suspected stroke in this study were prealerted by EMS
staff, regardless of eligibility, resulting in disagreements
with ED staff during handover. Aligning the expectations
of EMS and ED staff, perhaps through simplified prealert
protocols, could be considered to facilitate more
appropriate use of hospital prealerting in acute stroke.
https://emj.bmj.com/content/emermed/33/7/482.full.pdf
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
http://dx.doi.org/10.1136/emermed-2014-204392