Continuous Educational Interventions Help Emergency Medical Services Effectively Reduce the Therapeutic Time in Acute Ischemic Stroke

Abstract

Background: Early recognition of stroke symptoms, pre-notification to the hospital, and rapid transport of the patients has been associated with faster intervention and better outcomes. We studied the impact of continuous monthly educational intervention to the emergency medical services (EMS) members on the therapeutic time till mechanical thrombectomy in acute ischemic stroke. Methods: Our hospital manages Doctor Heli (DH) and Doctor Car (DC). Since April 2017, continuous monthly educational sessions on stroke care have been conducted involving the EMS doctors and paramedics, using the modalities like lectures and focus group discussions. We evaluated the change in performance time indicators prior to and after the initiation of this educational intervention. Results: In all, 10 patients underwent mechanical thrombectomy for acute ischemic stroke before and 36 patients underwent the procedure after the initiation of educational intervention program. The number of EMS-transported patients (by DH and DC) out of the total patients who underwent mechanical thrombectomy increased from 20% to 42% after the initiation of the educational intervention. The median time interval of onset to door (O2D) decreased from 109.5 to 71 minutes and that of door to recanalization (D2R) decreased from 164 to 88 minutes following the educational intervention. Other performance time indicators were also notably reduced. This improvement of time indicators was observed gradually and annually. Conclusion: This study showed that the continuous monthly education on stroke care to EMS members notably increased the number of EMS-transported patients as well as improved the performance time indicators till treatment in acute ischemic stroke.