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Updated: Apr 28, 2026

Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
Hospital-directed feedback to Emergency Medical Services improves prehospital performance
Bryan Choi1, Devin Tsai1, Celia Gomes McGillivray1
1From Department of Emergency Medicine (B.C.) and Stroke Center (C.A., J.-A.S., B.S.), Rhode Island Hospital, Providence; Department of Emergency Medicine (B.C.) and Department of Quality Management (C.G.M.), The Miriam Hospital, Providence, RI; and Department of Emergency Medicine (D.T.), Newport Hospital, RI.
Background And Purpose:
A potential way to improve prehospital stroke care and patient handoff is hospital-directed feedback for emergency medical service (EMS) providers. We evaluated whether a hospital-directed EMS stroke follow-up tool improved documentation of adherence to the Rhode Island state prehospital stroke protocol for EMS providers.
Methods:
A standardized, 10-item feedback tool was developed in 2012 and sent to EMS directors for every transported patient with a discharge diagnosis of ischemic stroke. We reviewed patient charts meeting these criteria between January 2008 and December 2013. Performance on the tool was compared between the preintervention (January 2008 through January 2012) and postintervention (February 2012 through December 2013) periods.
Results:
We identified 1176 patients with ischemic stroke who arrived by EMS in the study period: 668 in the preintervention period and 508 in the postintervention period. The overall score for the preintervention group was 5.31 and for the postintervention group 6.42 (P<0.001). Each of the 10 items, except checking blood glucose, showed statistically significant improvement in the postintervention period compared with the preintervention period.
Conclusions:
Hospital-directed feedback to EMS was associated with improved overall compliance with state protocols and documentation of 9 out of 10 individual items. Future confirmatory studies in different locales and studies on the impact of this intervention on actual tissue-type plasminogen activator administration rates and EMS personnel knowledge and behavior are needed.
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