While presentations of adults suffering stroke increased by more than 50% in a Queensland emergency department over a five-year period, new research has found that there were significant improvements in time performance measures.
In conjunction with Gold Coast Health, Griffith University researchers found multiple time targets improved in the ED, despite a 51.4% rise in patients presenting with stroke.
Stroke is a leading cause of mortality and morbidity, and places high demands on EDs.
The aim of the study was to evaluate stroke presentations in terms of demographics and time performance measures over a five-year period.
Dr Nijole Bernaitis and Associate Professor Shai Dukie (from Griffith University’s School of Pharmacy and Pharmacology), Professor Julia Crilly (from Griffith University’s Menzies Health Institute Queensland and Gold Coast Health’s Department of Emergency Medicine), and Dr Sean Bills (from Gold Coast Health’s Department of Emergency Medicine) worked on the retrospective study.
Prof Crilly said an increased awareness of stroke symptoms and the introduction of a new stroke code introduced during the study period, likely support the time performance improvements found in the study.
“The evolution of the Stroke code in ED was primarily due to our Neurology Service and ED team collaborating to identify patients with stroke who may benefit from early intervention,” Gold Coast Health’s Dr Bills added.
“This multidisciplinary approach and early involvement of the Neurologist in decision making in conjunction with the emergency team providing supportive care seems to have the desired effect on reducing emergency department length of stay.”
“Having therapies and treatments readily available can make a difference to patient outcomes. Before that though, we need to have processes in place that enable clinicians to assess and diagnose patients with stroke early, so that the most appropriate care can be delivered in the most appropriate environment.”
Dr Bernaitis based her PhD on the study to better inform stroke patient care in Australian EDs.
“Despite the increasing demand on ED and the time critical nature of stroke presentations, there is limited current data on stroke presentations to Australian EDs,” Dr Bernaitis said.
“There is a lack of information on the number of stroke presentations to EDs over recent years, the type of stroke (ischaemic or clots; and haemorrhagic or bleeds) and patient and health service outcomes such as timeliness of care to these patients.
“We looked at what happened to the patients once they arrived at the ED; it’s one thing to recognise a stroke in the ED but there are different presentations of stroke. “Better timing in the ED can relate to better outcomes, like treatment in the ward or shorter length of stay in hospital then rehabilitation.”
The study examined the median length of stay in the ED for haemorrhagic and ischaemic stroke presentations in the ED and found that these outcomes significantly decreased by nearly half, from 435 to 215 minutes and 451 to 238 minutes respectively.
The time it took to see a doctor according to triage priority also steadily decreased.
“Although there’s some emerging evidence around in terms of improving practices in the ED for patient with stroke, there’s definitely an impetus to having and further understanding the processes that are put in place,” Dr Bernaitis said.
“This work provides a foundation of understanding and awareness of the issue, and the importance and some of the outcomes that can arise from stroke. It didn’t specifically evaluate the stroke code but that could be a next step.”
A/Prof Dukie said the collaborative study highlighted success in conducting multidisciplinary research between the university and GCUH that has an impact.
The research has been published in International Emergency Nursing.