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Does primary stroke center certification change ED diagnosis, utilization, and disposition of patients with acute

Dustin W Ballard1, Mary E Reed, Jie Huang

  • 1Kaiser Permanente Department of Emergency Medicine (San Rafael), CA 94901, USA. dballard30@yahoo.com

The American Journal of Emergency Medicine
|November 22, 2011
PubMed

Insights

Primary stroke center certification improved emergency department care processes for stroke patients, including faster throughput and imaging times. However, certification did not lead to measurable improvements in patient survival.

Area of Science:

  • Neurology
  • Emergency Medicine
  • Health Services Research

Background:

  • Primary Stroke Center (PSC) certification aims to standardize and improve stroke care.
  • Evaluating the impact of PSC certification within integrated delivery systems is crucial for optimizing emergency department (ED) workflows.

Purpose of the Study:

  • To examine the effect of Primary Stroke Center certification on emergency department utilization and patient outcomes.
  • To assess changes in ED throughput, hospital admission, radiographic imaging, and mortality following PSC certification.

Main Methods:

  • A retrospective cohort study analyzed 30,461 stroke and transient ischemic attack (TIA) patients across 17 EDs.
  • Logistic and linear regression models adjusted for comorbidities, patient characteristics, and calendar time to compare pre- and post-certification outcomes.

Main Results:

  • PSC certification was linked to a 55-minute faster ED throughput for intracranial hemorrhage patients.
  • Utilization of cranial MRI for ischemic stroke increased (OR, 1.88), and time to imaging decreased significantly for various modalities.
  • No significant changes in patient survival were observed post-certification.

Conclusions:

  • Stroke center certification significantly altered ED admission and radiographic imaging patterns.
  • While care processes improved, measurable enhancements in survival were not evident.
Abstract

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