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A brief online education module improved emergency medical services (EMS) stroke recognition and hospital prenotification. However, these gains in stroke care were not sustained long-term, highlighting the need for ongoing strategies.

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Area of Science:

  • Emergency Medicine
  • Neurology
  • Public Health

Background:

  • Rapid stroke treatment is crucial and relies on prompt symptom recognition and hospital prenotification by emergency medical services (EMS).
  • A significant proportion of stroke patients (one-third) are not recognized by EMS, leading to delays in care.
  • Existing prehospital stroke care quality measures require improvement.

Purpose of the Study:

  • To assess the impact of a 30-minute online educational module and performance feedback system on EMS stroke recognition.
  • To evaluate the effect of the intervention on quality measure-compliant prehospital stroke care.
  • To analyze changes in emergency department performance and hospital outcomes following the intervention.

Main Methods:

  • An interrupted time series analysis was conducted over 24 months in a single Michigan county.
  • A registry of consecutive EMS-transported suspected or unrecognized stroke cases was used.
  • EMS stroke recognition rates, prenotification rates, and tissue-type plasminogen activator (tPA) delivery metrics were compared pre- and post-intervention.

Main Results:

  • EMS stroke recognition increased from 63.8% to 69.5% (P=0.037) post-intervention.
  • Hospital prenotification rates significantly improved from 60.9% to 77.3% (P<0.001).
  • There was a significant increase in tPA delivery within 45 minutes for ischemic stroke/transient ischemic attack patients (5.7% to 8.9%; P=0.042), though overall recognition gains were not sustained beyond 3 months.

Conclusions:

  • A brief educational intervention can improve EMS stroke recognition, prehospital notification, and timely tPA delivery.
  • The observed improvements were most prominent immediately after the educational module.
  • Performance feedback did not appear to sustain the initial gains in EMS stroke recognition, suggesting a need for ongoing educational or feedback strategies.