Abstract WP330: Hospital and EMS Collaborate to Improve Field Stroke Recognition

Background: Comprehensive Stroke Center (CSC) measure DSPR.2 recommends that hospitals collaborate with EMS providers regarding routing and transport plans and educational initiatives. Paramedics have a 61 -66% accuracy in identifying stroke cases with standard training, but this is reported to improve to 86-97% when training includes stroke-specific tools such as the Cincinnati Pre-hospital Stroke Scale (CPSS) or Los Angeles Pre-hospital Stroke Screen. 1 A CPSS-trained EMS team that transports cases to the neuroscience institute requested an assessment of their accuracy in diagnosing stroke in the field as compared to the actual discharge diagnosis. Method: Retrospective review of the EMS data for neurological transports and the hospital database between January 2010 and June 2012 to compare hospital discharge diagnosis to EMS field diagnosis using the CPSS. Result: Of the 74 cases transported for neurological evaluation, 57(77%) were thought to be strokes using the CPSS. At hospital discharge, 28/57(49%) had a confirmed diagnosis of stroke. Overall, 59/74(80%)were discharged with a neurological diagnosis. Conclusions: The accuracy of EMS diagnosis of stroke in the field fell far below their expectations based on the literature. This result led to an action plan for our hospital to partner with the EMS team to increase their accuracy by providing a higher level of education for stroke assessment. This presentation will discuss the performance improvement initiative undertaken by the hospital outreach team with the EMS providers. Based on quarterly case review results, this process may be expanded to include other local and regional EMS systems.