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Jafari M, Mahmoudian P, Ebrahimipour H, Vafaee-Nezhad R, Vafaee-Najar A, Hosseini SE, Haghighi H. Response Time and Causes of Delay in Prehospital Emergency Missions in Mashhad, 2015. Med J Islam Repub Iran 2022; 35:142. [PMID: 35321382 PMCID: PMC8840853 DOI: 10.47176/mjiri.35.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Indexed: 11/23/2022] Open
Abstract
Background: The response time is considered as one of the most important criteria for the quality of given care to the injured. This research aimed to investigate the frequency and causes of prehospital emergency delays in the 115 emergency center, in city of Mashhad, in 2015. Methods: In this cross-sectional study, 21,142 missions performed in 2015 were investigated, from among which 640 missions with delays in systematic sampling were recognized. For data analysis purposes, descriptive statistics (frequency, mean and SD) in Excel 2013 software was implemented. Results: Nearly 60% of the injured were men, 23% women, and the gender of 17% was not recorded in their profiles. The mean age of the injured was 29.8+15.9 years and 30% of the injured were in the age group of 16 to 25. The mean response time was 9:01+2:46. The most prevalent causes related to missions out of the operational zone (29.3%) and the second cause has been related to traffic groups (24.2%). Conclusion: Establishing new bases and completing the number of ambulances and human recourses, intervention in traffic causing factors, and training the public about emergency cases can be effective in reducing the number of missions and the pace and quality of services provided to the injured.
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Affiliation(s)
- Mehdi Jafari
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Payam Mahmoudian
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Ebrahimipour
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Vafaee-Nezhad
- Emergency Medical Services Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Vafaee-Najar
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyede-Elahe Hosseini
- Student Research Committee, School of Health Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hajar Haghighi
- Student Research Committee, School of Public Health, Health Management and Economics Department, Tehran University of Medical Sciences, Tehran, Iran
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Azami-Aghdash S, Moosavi A, Gharaee H, Sadeghi G, Mousavi Isfahani H, Ghasemi Dastgerdi A, Mohseni M. Development of quality indicators to measure pre-hospital emergency medical services for road traffic injury. BMC Health Serv Res 2021; 21:235. [PMID: 33726709 PMCID: PMC7970773 DOI: 10.1186/s12913-021-06238-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 03/03/2021] [Indexed: 01/01/2023] Open
Abstract
Background Pre-Hospital Emergency Care (PEC) is a fundamental property of prevention of Road Traffic Injuries (RTIs). Thus, this sector requires a system for evaluation and performance improvement. This study aimed to develop quality indicators to measure PEC for RTIs. Methods Following the related literature review, 14 experts were interviewed through semi-structured interviews to identify Quality Measurement Indicators (QMIs). The extracted indicators were then categorized into three domains: structure, performance, and management. Finally, the identified QMIs were confirmed through two rounds of the Delphi technique. Results Using literature review 11 structural, 13 performance, and four managerial indicators (A total of 28 indicators) were identified. Also, four structural, four performance, and three managerial indicators (A total of 11indicators) were extracted from interviews with experts. Two indicators were excluded after two rounds of Delphi’s technics. Finally, 14 structural, 16 performance and, seven managerial indicators (A total of 37indicators) were finalized. Conclusion Due to the importance and high proportion of RTIs compared to other types of injuries, this study set out to design and evaluate the QMIs of PEC delivered for RTIs. The findings of this research contribute to measuring and planning aimed at improving the performance of PEC. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06238-1.
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Affiliation(s)
- Saber Azami-Aghdash
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Moosavi
- Department of Health and Community Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Hojatolah Gharaee
- District Health Center of Hamadan City, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ghader Sadeghi
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Haleh Mousavi Isfahani
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Ghasemi Dastgerdi
- Disaster and Emergency Medical Management Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Mohseni
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Vrudhula A, Zhao J, Liu R. Too Young to Have a Stroke?-a Global Health Crisis. Stroke Vasc Neurol 2019; 4:173-175. [PMID: 32030199 PMCID: PMC6979873 DOI: 10.1136/svn-2019-000295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 12/13/2022] Open
Abstract
This editorial discusses the importance of improving awareness of stroke in young individuals. Stoke can occur in any age group and is not restricted to elderly populations. Today, the average age of the first-time stroke patient continues to decrease. However, the incidence of stroke in seemingly healthy, young adults remains neglected, and stroke awareness among young patients remains poor, even in well-developed countries. Education targeting two common barriers to stroke care, identification and rescue, should be implemented for both medical professionals and the public domain. Only through education can we reduce preventable stroke-related death and damage in young patients moving forward.
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Affiliation(s)
- Amey Vrudhula
- Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jing Zhao
- Minhang Hospital, Fudan University, Shanghai, China
| | - Renyu Liu
- Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Receptionist rECognition and rEferral of Patients with Stroke (RECEPTS): unannounced simulated patient telephone call study in primary care. Br J Gen Pract 2016; 65:e421-7. [PMID: 26120134 PMCID: PMC4484942 DOI: 10.3399/bjgp15x685621] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Stroke is a leading cause of morbidity and mortality. Timely recognition and referral are essential for treatment. Aim To examine the ability of receptionists in general practices to recognise symptoms of stroke and direct patients to emergency care. Design and setting Unannounced simulated patient telephone calls and prospective cross-sectional survey study in general practices in the Birmingham and Solihull area. Method A total of 52 general practices participated in a total of 520 simulated telephone calls, with 183 receptionists completing questionnaires. Logistic regression analyses were used to examine likelihood of referral for immediate care by ease of vignette recognition and number of common stroke symptoms present. Results General practice receptionists correctly referred 69% of simulated calls for immediate care. Calls classed as ‘difficult’ to recognise were less likely to be immediately referred. Compared with ‘easy’ calls: ‘difficult’ calls odds ratio (OR) 0.15, 95% confidence interval (CI) = 0.08 to 0.26; ‘moderate’ calls OR 0.55, 95% CI = 0.32 to 0.92. Similarly, calls including one or two ‘FAST’ symptoms were less likely to be referred immediately (compared with three FAST symptoms: one symptom OR 0.30, 95% CI = 0.13 to 0.72; two symptoms OR 0.35, 95% CI = 0.15 to 0.83). Conclusion General practice receptionists refer patients with stroke for immediate care when they present with several symptoms; however, they are less likely to refer patients presenting with only one symptom or less common symptoms of stroke. Optimum management of acute stroke in primary care requires interventions that improve receptionists’ knowledge of lesser-known stroke symptoms.
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Badachi S, Mathew T, Prabhu A, Nadig R, Sarma GRK. Hurdles in stroke thrombolysis: Experience from 100 consecutive ischemic stroke patients. Ann Indian Acad Neurol 2015; 18:415-8. [PMID: 26713013 PMCID: PMC4683880 DOI: 10.4103/0972-2327.165460] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Acute management of ischemic stroke involves thrombolysis within 4.5 h. For a successful outcome, early recognition of stroke, transportation to the hospital emergency department immediately after stroke, timely imaging, proper diagnosis, and thrombolysis within 4.5 h is of paramount importance. Aim: To analyze the obstacles for thrombolysis in acute stroke patients. Materials and Methods: The study was conducted in a tertiary care center in South India. A total of hundred consecutive patients of acute ischemic stroke who were not thrombolysed, but otherwise fulfilled the criteria for thrombolysis were evaluated prospectively for various factors that prevented thrombolysis. The constraints to thrombolysis were categorized into: i) Failure of patient to recognize stroke symptoms, ii) patient's awareness of thrombolysis as a treatment modality for stroke, iii) failure of patient's relative to recognize stroke, iv) failure of primary care physician to recognize stroke, v) transport delays, vi) lack of neuroimaging and thrombolysis facility, and vii) nonaffordability. Results: The biggest hurdle for early hospital presentation is failure of patients to recognize stroke (73%), followed by lack of neuroimaging facility (58%), nonaffordability (56%), failure of patient's relative to recognize stroke (38%), failure of the primary care physician to recognize stroke (21%), and transport problems (13%). Awareness of thrombolysis as a treatment modality for stroke was seen only in 2%. Conclusion: Considering the urgency of therapeutic measures in acute stroke, there is necessity and room for improvement to overcome various hurdles that prevent thrombolysis.
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Affiliation(s)
- Sagar Badachi
- Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Thomas Mathew
- Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Arvind Prabhu
- Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Raghunandan Nadig
- Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Gosala R K Sarma
- Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India
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Mohammadi M, Nasiripour AA, Fakhri M, Bakhtiari A, Azari S, Akbarzadeh A, Goli A, Mahboubi M. The evaluation of time performance in the emergency response center to provide pre-hospital emergency services in Kermanshah. Glob J Health Sci 2014; 7:274-9. [PMID: 25560357 PMCID: PMC4796334 DOI: 10.5539/gjhs.v7n1p274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/10/2014] [Indexed: 11/12/2022] Open
Abstract
This study evaluated the time performance in the emergency response center to provide pre-hospital emergency services in Kermanshah. This study was a descriptive retrospective cross-sectional study. In this study 500 cases of patients from Shahrivar (September) 2012 to the end of Shahrivar (September) 2013 were selected and studied by the non-probability quota method. The measuring tool included a preset cases record sheet and sampling method was completing the cases record sheet by referring to the patients’ cases. Data were analyzed using SPSS version 18 and the concepts of descriptive and inferential statistics (Kruskal-Wallis test, benchmark Eta (Eta), Games-Howell post hoc test). The results showed that the interval mean between receiving the mission to reaching the scene, between reaching the scene to moving from the scene, and between moving from the scene to a health center was 7.28, 16.73 and 7.28 minutes. The overall mean of time performance from the scene to the health center was 11.34 minutes. Any intervention in order to speed up service delivery, reduce response times, ambulance equipment and facilities required for accuracy, validity and reliability of the data recorded in the emergency dispatch department, Continuing Education of ambulance staffs, the use of manpower with higher specialize levels such as nurses, supply the job satisfaction, and increase the coordination with other departments that are somehow involved in this process can provide the ground for reducing the loss and disability resulting from traffic accidents.
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Affiliation(s)
| | | | | | | | | | | | | | - Mohammad Mahboubi
- Assistant professor, Abadan School of Medical Sciences and Health Services,Abadan, Iran AND kermanshah university of medical sciences, kermanshah,Iran.
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Rymer MM, Anderson CS, Harada M, Jarosz J, Ma N, Rowley HA, Summers D, Tastula K, Williams O, Bornstein NM. Stroke service: how can we improve and measure outcomes? Consensus summary from a global stroke forum. Acta Neurol Scand 2014; 130:73-80. [PMID: 24796345 DOI: 10.1111/ane.12256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2014] [Indexed: 11/27/2022]
Abstract
The success of acute stroke treatment is first and foremost time-dependent, and the need for improvement in acute stroke management is demonstrated by the fact that only a minority of patients gain access to treatment - in particular, intravenous recombinant tissue plasminogen activator (IV tPA) - within the necessary time window. Standards of acute stroke care vary widely both regionally and nationally; consequently, various healthcare organizations have undertaken initiatives to measure and improve quality of care. To date, most quality measures have been process-based, focusing primarily on metrics of patient care in the acute hospital-based setting (e.g., time to recombinant tPA administration). Therefore, there remains a need for metrics designed to assess how improvements in process translate into patient outcomes. A global forum was convened to share best practice and provide consensus recommendations on core metrics for measuring improvements in access to care and patient outcomes. Recommendations for core metrics of patient outcomes include hospital-based outcomes (e.g., neurological status at 24 h, ambulatory status at discharge) and post-discharge outcomes (e.g., modified Rankin Scale score at 30 and/or 90 days). Recommendations for best practice relating to aspects of people, process, and technology involved in the stroke treatment pathway that may help provide improvements in these core outcome measures are also outlined.
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Affiliation(s)
- M. M. Rymer
- The University of Kansas Hospital; Kansas City KS USA
| | - C. S. Anderson
- The George Institute for Global Health; Royal Prince Alfred Hospital; University of Sydney; Sydney NSW Australia
| | - M. Harada
- University of Tokushima; Tokushima Japan
| | | | - N. Ma
- Beijing Tiantan Hospital; Beijing China
| | - H. A. Rowley
- School of Medicine and Public Health; University of Wisconsin; Madison WI USA
| | - D. Summers
- St Luke's Neuroscience Institute; Kansas City MO USA
| | - K. Tastula
- Royal Prince Alfred Hospital; Sydney NSW Australia
| | | | - N. M. Bornstein
- Tel-Aviv Medical Center; Tel-Aviv University; Tel-Aviv Israel
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Factors Related to Decision Delay in Acute Stroke. J Stroke Cerebrovasc Dis 2014; 23:534-9. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.05.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/02/2013] [Accepted: 05/06/2013] [Indexed: 11/18/2022] Open
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Denetclaw TH, Cefalu P, Manila LL, Panagotacos JJ. Needs analysis for educating community pharmacists to interface with prehospital stroke chain of survival. J Stroke Cerebrovasc Dis 2012; 23:209-12. [PMID: 23253532 DOI: 10.1016/j.jstrokecerebrovasdis.2012.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 11/16/2012] [Accepted: 11/19/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Awareness of the American Heart Association's Stroke Chain of Survival, and willingness to learn and share this information with the public, was assessed for community pharmacists practicing near a primary stroke center. METHODS Twenty-three community pharmacies local to a primary stroke center were identified and surveyed. The surveyor showed each pharmacist a flier with a mnemonic for assessing stroke symptoms, briefly explained steps in the Stroke Chain of Survival, and noted if the pharmacist was available, listened to the entire presentation, read the information on the flier, agreed to post the flier, and if the pharmacist made any comments. The surveyor also assessed whether the Stroke Chain of Survival was new information to each pharmacist. RESULTS All subjects read the information on the flier. Twenty-two (95.7%) listened to the entire presentation, and 23 (100%) were willing to post the flier. Two (11%) indicated that the parent company does not allow public posting of noncorporate information but agreed to post the flier internally. Twenty-one (91%) expressed appreciation for receiving the information. Seventeen (74%) indicated that the Stroke Chain of Survival was new information to them, 14 (61%) spontaneously remarked on the importance of the information, and 4 (17%) asked for additional information. CONCLUSIONS Community pharmacists surveyed were willing to interface with the prehospital phase of the Stroke Chain of Survival; nearly 75% of them required education to do so. Community pharmacies are potentially a venue for educating the public on the Stroke Chain of Survival. It may be necessary to approach community pharmacy corporate leadership to partner with such efforts.
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Affiliation(s)
- Tina Harrach Denetclaw
- Pharmacy Department, Marin General Hospital, University of California, San Francisco; Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco.
| | - Patricia Cefalu
- Cardiovascular Division, Marin General Hospital, Marin General Hospital, Greenbrae, California
| | - Louis L Manila
- Haynes Cardiovascular Institute, Marin General Hospital, Greenbrae, California
| | - John J Panagotacos
- Pharmacy Department, Marin General Hospital, University of California, San Francisco
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Rhoney DH. Contemporary Management of Transient Ischemic Attack: Role of the Pharmacist. Pharmacotherapy 2011; 31:193-213. [DOI: 10.1592/phco.31.2.193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Abilleira S, Lucente G, Ribera A, Permanyer-Miralda G, Gallofré M. Patient-related features associated with a delay in seeking care after stroke. Eur J Neurol 2010; 18:850-6. [PMID: 21143338 DOI: 10.1111/j.1468-1331.2010.03258.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Different factors may weight on time from stroke onset to hospital arrival, and patients' alert certainly contributes to it. We sought to identify clinical and sociodemographic factors associated with a delayed alert and to delineate the profile of the potential latecomer in Catalonia (Spain). METHODS We used data from the Stroke Code (SC) registry that prospectively recruited consecutive patients with acute stroke, in whom SC was activated (SCA) or not (SCNA), admitted to all Catalan hospitals. Additionally, SCNA patients underwent a structured interview to explore additional beliefs and attitudes related to a delayed alert. We applied a 6-h cut-off to define alert delay according to the time limit for SC activation in Catalonia. We determined independent predictors of delay amongst clinical and sociodemographic data by multivariate logistic regression and applied sample weighting because of different study periods in the SCA and SCNA arms. RESULTS Of the patients, 37.2% delayed alert beyond 6 h. Compared to non-delayers, latecomers were more likely diabetics, illiterates, belonged to an unfavored social class, and were living alone. Fewer had concomitant atrial fibrillation and alerted through emergency medical service (EMS)/112 whilst suffering a mild or moderate stroke. Amongst patients interviewed, being unaware of stroke's vascular nature and erroneously self-perceiving stroke as a reversible or irrelevant condition independently predicted a longer delay. CONCLUSIONS Delaying alert after stroke shows a multifactorial background with implication of pre-stroke health status, socioeconomic factors, stroke-related features and patients' beliefs and attitudes toward the disease. In planning future educational campaigns, all these features should be considered.
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Affiliation(s)
- S Abilleira
- Stroke Programme, Catalan Agency for Health Technology Assessment and Research, Barcelona, Spain.
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Abstract
Despite the proven benefits of thrombolysis for patients presenting with acute ischemic stroke, only a limited number of patients receive thrombolytic therapy. The reason for the low treatment rate is that thrombolysis is only effective a few hours after the onset of ischemic stroke, so delays in patients being admitted to hospital and being diagnosed mean that the therapeutic window is often missed. Major factors that lead to prehospital delay include the general public's lack of knowledge of stroke symptoms and their poor understanding of the appropriate course of action following a stroke. Indeed, the patients who arrive early in hospital tend to be those who recognize the symptoms of stroke and take them seriously. Deficiencies in the identification of stroke by emergency medical services and general practitioners also contribute to prehospital delay. Aggressive, combined educational programs aimed at the general public, general practitioners, and medical and paramedical hospital staff can lead to increased stroke treatment rates. In this Review, we explore the extent of prehospital delay in stroke, identify the factors that affect the time taken for patients to reach hospital, and describe strategies designed to reduce the delay.
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Affiliation(s)
- Miriam Bouckaert
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
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Vermeidung von Zeitverzögerungen im Management akuter Schlaganfallpatienten. Analyse des österreichischen Stroke-Unit-Registers. Wien Med Wochenschr 2008; 158:418-24. [DOI: 10.1007/s10354-008-0564-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 05/27/2008] [Indexed: 10/21/2022]
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Middleton S, Levi C, Dale S. Arrival Time to Stroke Unit as Crucial a Measure as Arrival Time to Emergency Department. Stroke 2008; 39:e5. [DOI: 10.1161/strokeaha.107.501890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Sandy Middleton
- School of Nursing (NSW & ACT), ACU National, North Sydney NSW, Australia
| | - Christopher Levi
- Hunter Stroke Service, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Simeon Dale
- Quality in Acute Stroke Project, School of Nursing (NSW & ACT), ACU National, North Sydney NSW, Australia
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