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A geographic information system analysis of the impact of a statewide acute stroke emergency medical services routing protocol on community hospital bypass.

Publication ,  Journal Article
Asimos, AW; Ward, S; Brice, JH; Enright, D; Rosamond, WD; Goldstein, LB; Studnek, J
Published in: J Stroke Cerebrovasc Dis
2014

BACKGROUND: Our goal was to determine if a statewide Emergency Medical Services (EMSs) Stroke Triage and Destination Plan (STDP), specifying bypass of hospitals unable to routinely treat stroke patients with thrombolytics (community hospitals), changed bypass frequency of those hospitals. METHODS: Using a statewide EMS database, we identified stroke patients eligible for community hospital bypass and compared bypass frequency 1-year before and after STDP implementation. RESULTS: Symptom onset time was missing for 48% of pre-STDP (n = 2385) and 29% of post-STDP (n = 1612) cases. Of the remaining cases with geocodable scene addresses, 58% (1301) in the pre-STDP group and 61% (2,078) in the post-STDP group were ineligible for bypass, because a community hospital was not the closest hospital to the stroke event location. Because of missing data records for some EMS agencies in 1 or both study periods, we included EMS agencies from only 49 of 100 North Carolina counties in our analysis. Additionally, we found conflicting hospital classifications by different EMS agencies for 35% of all hospitals (n = 38 of 108). Given these limitations, we found similar community hospital bypass rates before and after STDP implementation (64%, n = 332 of 520 vs. 63%, n = 345 of 552; P = .65). CONCLUSIONS: Missing symptom duration time and data records in our state's EMS data system, along with conflicting hospital classifications between EMS agencies limit the ability to study statewide stroke routing protocols. Bypass policies may apply to a minority of patients because a community hospital is not the closest hospital to most stroke events. Given these limitations, we found no difference in community hospital bypass rates after implementation of the STDP.

Duke Scholars

Published In

J Stroke Cerebrovasc Dis

DOI

EISSN

1532-8511

Publication Date

2014

Volume

23

Issue

10

Start / End Page

2800 / 2808

Location

United States

Related Subject Headings

  • Triage
  • Treatment Outcome
  • Transportation of Patients
  • Time-to-Treatment
  • Thrombolytic Therapy
  • Stroke
  • Regional Health Planning
  • Program Evaluation
  • North Carolina
  • Neurology & Neurosurgery
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Asimos, A. W., Ward, S., Brice, J. H., Enright, D., Rosamond, W. D., Goldstein, L. B., & Studnek, J. (2014). A geographic information system analysis of the impact of a statewide acute stroke emergency medical services routing protocol on community hospital bypass. J Stroke Cerebrovasc Dis, 23(10), 2800–2808. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.07.004
Asimos, Andrew W., Shana Ward, Jane H. Brice, Dianne Enright, Wayne D. Rosamond, Larry B. Goldstein, and Jonathan Studnek. “A geographic information system analysis of the impact of a statewide acute stroke emergency medical services routing protocol on community hospital bypass.J Stroke Cerebrovasc Dis 23, no. 10 (2014): 2800–2808. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.07.004.
Asimos AW, Ward S, Brice JH, Enright D, Rosamond WD, Goldstein LB, et al. A geographic information system analysis of the impact of a statewide acute stroke emergency medical services routing protocol on community hospital bypass. J Stroke Cerebrovasc Dis. 2014;23(10):2800–8.
Asimos, Andrew W., et al. “A geographic information system analysis of the impact of a statewide acute stroke emergency medical services routing protocol on community hospital bypass.J Stroke Cerebrovasc Dis, vol. 23, no. 10, 2014, pp. 2800–08. Pubmed, doi:10.1016/j.jstrokecerebrovasdis.2014.07.004.
Asimos AW, Ward S, Brice JH, Enright D, Rosamond WD, Goldstein LB, Studnek J. A geographic information system analysis of the impact of a statewide acute stroke emergency medical services routing protocol on community hospital bypass. J Stroke Cerebrovasc Dis. 2014;23(10):2800–2808.
Journal cover image

Published In

J Stroke Cerebrovasc Dis

DOI

EISSN

1532-8511

Publication Date

2014

Volume

23

Issue

10

Start / End Page

2800 / 2808

Location

United States

Related Subject Headings

  • Triage
  • Treatment Outcome
  • Transportation of Patients
  • Time-to-Treatment
  • Thrombolytic Therapy
  • Stroke
  • Regional Health Planning
  • Program Evaluation
  • North Carolina
  • Neurology & Neurosurgery