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Training emergency services' dispatchers to recognise stroke: an interrupted time-series analysis

Watkins, CL, Leathley, MJ, Jones, SP, Ford, GA, Quinn, T and Sutton, CJ (2013) Training emergency services' dispatchers to recognise stroke: an interrupted time-series analysis BMC Health Services Research.

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Abstract

Background: Stroke is a time-dependent medical emergency in which early presentation to specialist care reduces death and dependency. Up to 70% of all stroke patients obtain first medical contact from the Emergency Medical Services (EMS). Identifying 'true stroke' from an EMS call is challenging, with over 50% of strokes being misclassified. The aim of this study was to evaluate the impact of the training package on the recognition of stroke by Emergency Medical Dispatchers (EMDs). Methods. This study took place in an ambulance service and a hospital in England using an interrupted time-series design. Suspected stroke patients were identified in one week blocks, every three weeks over an 18 month period, during which time the training was implemented. Patients were included if they had a diagnosis of stroke (EMS or hospital). The effect of the intervention on the accuracy of dispatch diagnosis was investigated using binomial (grouped) logistic regression. Results: In the Pre-implementation period EMDs correctly identified 63% of stroke patients; this increased to 80% Post-implementation. This change was significant (p=0.003), reflecting an improvement in identifying stroke patients relative to the Pre-implementation period both the During-implementation (OR=4.10 [95% CI 1.58 to 10.66]) and Post-implementation (OR=2.30 [95% CI 1.07 to 4.92]) periods. For patients with a final diagnosis of stroke who had been dispatched as stroke there was a marginally non-significant 2.8 minutes (95% CI -0.2 to 5.9 minutes, p=0.068) reduction between Pre- and Post-implementation periods from call to arrival of the ambulance at scene. Conclusions: This is the first study to develop, implement and evaluate the impact of a training package for EMDs with the aim of improving the recognition of stroke. Training led to a significant increase in the proportion of stroke patients dispatched as such by EMDs; a small reduction in time from call to arrival at scene by the ambulance also appeared likely. The training package has been endorsed by the UK Stroke Forum Education and Training, and is free to access on-line. © 2013 Watkins et al.; licensee BioMed Central Ltd.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Health Sciences
Authors :
AuthorsEmailORCID
Watkins, CLUNSPECIFIEDUNSPECIFIED
Leathley, MJUNSPECIFIEDUNSPECIFIED
Jones, SPUNSPECIFIEDUNSPECIFIED
Ford, GAUNSPECIFIEDUNSPECIFIED
Quinn, TUNSPECIFIEDUNSPECIFIED
Sutton, CJUNSPECIFIEDUNSPECIFIED
Date : 20 August 2013
Identification Number : 10.1186/1472-6963-13-318
Related URLs :
Additional Information : © 2013 Watkins et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Depositing User : Symplectic Elements
Date Deposited : 25 Aug 2015 09:02
Last Modified : 25 Aug 2015 09:02
URI: http://epubs.surrey.ac.uk/id/eprint/808301

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