Templates for Organizing Stroke Triage

1
Templates for Organizing Stroke Triage
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Getting Started

• Physician leader to guide and champion the effort
• Other sources of support

• Physicians
• Hospital administration
• Medical Society
• Hospital Council
• Stroke survivor groups
• Other community groups

• Insurance companies
• AHA
• NSA
• Political sources

3
Physician Buy-in

• Stroke Team
• Obtaining physician participation
• Appeal to their sense of duty
• Demonstrations of efficacy
• Utilization of ER physicians for neurological
  assessment
• Teleradiology
• Help from medical board
• Financial assistance from hospital
• Training programs

4
Hospital Administration Buy-in

• Stroke program essential for large hospitals
• May enhance image of all hospitals, increase
  volume and improve outcomes
• Procedures developed may result in cost savings
  for hospital and improve outcomes
• Board of trustees may be helpful

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Forming Networks of Centers

• Steering committee
• Establish criteria for participation
• Open invitation for all to participate
• Try to include whole community
• Strong participation from EMS
• Endorsements from Medical Society
• Endorsements from Hospital Council
• Minimal financial impact on non-participating
  hospitals
• Community groups
• Political support--local and national

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9-1-1 Call Center

• Emergency Medical Dispatch
• Caller Accuracy is Rate Limiting Factor
• Possible Stroke v. Fall v. Diabetic Problem
• Key Questions
• Awake?
• Breathing Normally?

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EMS Assessment

• SFFD Stroke Recognition Training
• Before 61
• After 91
• LAPSS
• 91 Sensitive
• 97 Specific

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Field Neurological Exam

• Symmetric Smile
• Equal Grip
• Arm Drift
• Simple Phrase

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Key Information

• Exact Onset of Symptoms
• Bring Witnesses, Family Members
• History of Seizure Disorder
• Diabetes?
• Finger Stick Glucose
• Previous Neurologic Status

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Destination Selection

• Must Have Stroke System in Place
• 24/7 Coverage
• Rotating Schedule
• Geographic Balance
• Diversion Contingencies

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The Future

• The task force envisions the development of
  local, and eventually state and national
  guidelines for stroke care delivery, including
  prehospital stroke care. In anticipation of these
  developments, this document has been created to
  help communities begin to pursue these goals.

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Task Force Recommendations

• Evaluate its stroke care system capabilities
  regarding
• Public awareness of the signs and symptoms of
  stroke
• Prioritization of potential stroke patients
  within EMS dispatch protocols
• Training of EMS professionals in recognition and
  treatment of stroke
• Uniformity of prehospital stroke care protocols
  among all EMS provider agencies
• Uniformity of transportation algorithms and
  destination protocols for stroke patients
• Identification of hospital resources regarding
  stroke care

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Continued Recommendations

• Identify or create a community organization to
  implement and oversee the stroke care system
• Ensure competency for all components of the EMS
  system and participating hospitals in assessing
  and treating patients with acute stroke.
• Prioritize dispatch of acute stroke patients
  similar to that assigned to patients with major
  injury and acute myocardial infarction.

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Continued Recommendations

• Develop triage protocols for preferential stroke
  patient transport (including inter-hospital
  transfers) to designated stroke center hospitals
  
• Collect, analyze, and share EMS and stroke center
  hospital data among participating EMS systems and
  hospitals for purposes of quality improvement and
  patient outcome.
• Develop local guidelines for stroke care
  delivery, including prehospital stroke care.