Abstract TP54: Prehospital Stroke Notification: No Record, Didn’t Happen

Introduction: Acute strokes necessitate streamlined communication between first responders and physicians regarding stroke signs ascertained in the field. Stroke alert protocols that dictate hospital resource activation contribute to the speed in which potential cases are assessed and treated. We studied associations between EMS stroke pre-notification and ED stroke alert activation behavior at a Comprehensive Stroke Center. Methods: This retrospective chart review identified patients who arrived via EMS and were ultimately stroke alerted from the ED between April 2020 and July 2021. Data was collected manually through a state-wide EMS record exchange and internal hospital databases to include EMS documentation of attempts to alert the ED to stroke, time of ED stroke alert activation, and final discharge diagnosis. Descriptive statistics are presented as counts and percentages. Results: Among the 472 cases of stroke alerted patients, 214 (45.3%) were discharged with a final diagnosis of acute stroke. There were 167 (35.4%) patients where EMS documented attempts to pre-notify the hospital of a potential stroke, versus 210 (45%) whose records lacked explicit note of pre-notification. EMS records could not be found in 94 (20.2%) cases. Among 167 known cases where EMS attempted hospital pre-notification, the ED activated a stroke alert prior to hospital arrival in 69 (41.3%). Among 210 cases where EMS did not record pre-notification, the ED stroke pre-alerted 23 (11.0%), suggesting gaps in EMS documentation of completed stroke pre-notifications. Of 94 patients who lacked EMS records, 29 (30.9%) were pre-alerted to stroke by the ED. Finally, among 214 patients discharged with acute stroke, 96 (44.9%) had documented EMS stroke pre-notifications, of which 46 (21.5%) received ED pre-alerts. An additional 24 (11.2%) stroke patients who lacked sufficient documentation were stroke alerted by the ED prior to hospital arrival. Conclusions: Quality in communications spanning from EMS to physicians is a crucial prerequisite to timely stroke care. Gaps in EMS records and ED stroke alert activation lend support to a need for standardization in stroke documentation and stroke alert protocols, which may streamline data access and improve patient experience of care.