Agreement between ambulance nurses and physicians in assessing stroke patients

Area of Science:

• Emergency Medicine
• Neurology
• Healthcare Quality Improvement

Background:

• Direct transport of suspected stroke patients to CT scanners could reduce time to thrombolysis.
• Assessing the agreement between ambulance nurses and emergency physicians is crucial for implementing this pathway.

Purpose of the Study:

• To evaluate the agreement between ambulance nurses and emergency physicians in determining the need for CT scans in suspected stroke patients.
• To assess agreement on necessary pre-CT interventions and monitoring.

Main Methods:

• A comparative study involving 200 patients with stroke symptoms between October 2008 and June 2009.
• Both ambulance nurses and emergency physicians answered identical questionnaires regarding CT scan necessity and pre-scan care.

Main Results:

• Poor agreement was found for CT scan decisions (κ = 0.22) and pre-CT interventions/monitoring (κ = 0.32).
• Nurses' sensitivity for CT scan selection was 84%, but specificity was only 37%.
• In 18% of cases, nurses deemed necessary interventions unnecessary compared to physicians.

Conclusions:

• Current agreement levels are insufficient for ambulance nurses to independently direct suspected stroke patients to CT scanners.
• Additional decision support tools are required to enhance nurses' judgment before direct CT scanning pathways can be safely implemented.