• Does use of the recognition of stroke in the emergency room stroke assessment tool enhance stroke recognition by ambulance clinicians?

      Fothergill, Rachael; Williams, Julia; Edwards, Melanie J.; Russell, Ian T.; Gompertz, Patrick (2013-11)
    • Frequent callers to the ambulance service: patient profiling and impact of case management on patient utilisation of the ambulance service

      Edwards, Melanie J.; Bassett, Gary; Sinden, Levi; Fothergill, Rachael (2015-05)
      Background A minority of patients make frequent and excessive calls to the ambulance service, placing a significant burden on limited resources at a time when demand on urgent and emergency care systems is steadily increasing. Little is known about the reasons underlying frequent caller behaviour or the best way to manage this group of patients. Objectives The present study aimed to (i) profile frequent callers to the ambulance service and (ii) evaluate the impact of a case management interventional approach on frequent caller behaviour. Methods A retrospective review of data from a 2-year period (from 1 April 2009 to 31 March 2011) was conducted. Patients were included in the analysis if they had been accepted for case management intervention by the Patient-Centred Action Team during this period and met the study inclusion criteria. Results The review identified 110 frequent callers who met the study inclusion criteria. The majority of frequent callers (86%) had multiple and complex reasons for calling, including frequent medical need, acute or chronic mental health condition, older age and unmet personal or social care needs. In the majority of cases (82%), multiple interventional strategies were required. A significant reduction in median call volume was observed from preintervention to postintervention (from five calls/month to zero calls/month). Conclusions Effective management of this complex patient group requires an individualised case management approach in order to identify and tackle the underlying causes of behaviour. https://emj.bmj.com/content/32/5/392.long 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-2013-203496
    • Stroke mimics in the pre-hospital setting

      Edwards, Melanie J.; Fothergill, Rachael; Williams, Julia; Gompertz, Patrick (2015-05)
      Accurate identification of stroke patients is essential to ensure appropriate and timely treatment. Stroke mimics —patients initially suspected to have suffered a stroke who are subsequently diagnosed with a condition other than stroke —are estimated to account for 5 –33% of suspected stroke patients conveyed by paramedics to a hospital stroke unit. The prevalence of stroke mimics in London has not been investigated although pan-London hospital data suggests that one quarter of all patients admitted to hyper-acute stroke units (HASUs) are stroke mimics. Participants were recruited as part of a larger study investigating whether the use of the Recognition of Stroke in the Emergency Room (ROSIER) tool by ambulance crews improved pre-hospital stroke recognition. Only patients indicated by the ROSIER to have potentially suffered a stroke and conveyed to a participating HASU (n=256) were included. A final diagnosis of stroke was received by 160 patients (“strokes”) while 96 patients received a final diagnosis of nonstroke (“mimics”), resulting in a stroke mimic rate of 38%. Mimics received a wide range of diagnoses, including seizure, syncope, brain tumour, non-organic stroke/symptoms, sepsis, somatisation, and migraine. Compared to strokes, mimics had a lower total ROSIER score, displayed fewer stroke-related symptoms, and presented with more symptoms not indicative of a stroke (e.g. loss of consciousness/syncope, seizure). The stroke mimic rate is higher than reported by previous studies and pan-London hospital data. It is unlikely this higher rate is due to the use of the ROSIER since the speci ficity of the ROSIER is equal to the FAST in the pre-hospital setting (Fothergill et al, submitted). Stroke recognition in the prehospital setting needs to be improved in order to reduce the number of non-strokes falsely identi fied as stroke and to ensure these patients are taken to the appropriate facility for treatment. https://emj.bmj.com/content/emermed/32/5/e8.2.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-2015-204880.22