How do interventions to improve the efficiency of acute stroke care affect prehospital times? A systematic review and narrative synthesis

Graham McClelland; Sarah Hepburn; Tracy Finch; Christopher I Price

doi:10.1186/s12873-022-00713-6

How do interventions to improve the efficiency of acute stroke care affect prehospital times? A systematic review and narrative synthesis

BMC Emerg Med. 2022 Sep 3;22(1):153. doi: 10.1186/s12873-022-00713-6.

Authors

Graham McClelland^{1

2}, Sarah Hepburn³, Tracy Finch⁴, Christopher I Price⁵

Affiliations

¹ Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, England. graham.mcclelland@neas.nhs.uk.
² North East Ambulance Service NHS Foundation Trust, Bernicia House, Goldcrest Way, Newburn Riverside, Newcastle upon Tyne, NE15 8NY, England. graham.mcclelland@neas.nhs.uk.
³ North East Ambulance Service NHS Foundation Trust, Bernicia House, Goldcrest Way, Newburn Riverside, Newcastle upon Tyne, NE15 8NY, England.
⁴ Department of Nursing, Midwifery & Health, Northumbria University, Room B126 Coach Lane Campus West, Newcastle upon Tyne, NE7 7XA, England.
⁵ Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, England.

Abstract

Background: Emergency medical services (EMS) are the first point of contact for most acute stroke patients. EMS call to hospital times have increased in recent years for stroke patients in the UK which is undesirable due to the relationship between time and effectiveness of reperfusion treatment. This review aimed to identify and describe interventions devised to improve the efficiency of acute stroke care which reported an impact on ground-based EMS call to hospital times.

Methods: A systematic review of published literature identified from five databases (Medline, EMBASE, CINAHL, the Cochrane library and the Database of Research in Stroke (DORIS)) from January 2000 to December 2020 with narrative synthesis was conducted. Inclusion criteria were primary studies of ground-based EMS, focused on stroke and aiming to improve EMS times. Papers published before 2000, focussing on mobile stroke units or in languages other than English were excluded. Two reviewers independently screened prospective titles. Cochrane ROB2 and ROBINS-I tools were used to assess for risk of bias. This review was funded by a Stroke Association fellowship.

Results: From 3767 initial records, 11 studies were included in the review. Included studies were categorised into three groups: studies targeting EMS dispatch and EMS clinicians (n = 4); studies targeting EMS clinicians only (n = 4); and studies targeting whole system change (n = 3). Suspected stroke patients were the primary population studied and most (n = 10) interventions involved clinician education. Only one study (9%) reported a significant decrease in call to hospital time in one subgroup whereas two studies (18%) reported a significant increase in call to hospital time and all other studies (73%) reported no significant change.

Conclusions: Based on the included studies, interventions intended to improve the efficiency of the acute stroke pathway rarely improved EMS call to hospital times. Included studies were heterogenous and rarely focussed on the review topic which limits the usability of the findings. Further research is needed to explore the trade-off between changes to EMS stroke care and call to hospital times and subsequent impacts on in-hospital care and patient outcomes.

Keywords: Prehospital; Stroke; Times.

Publication types

Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Critical Care
Emergency Medical Dispatch*
Emergency Medical Services*
Humans
Prospective Studies
Stroke* / therapy