Stroke-related education to emergency department staff: An acute stroke care quality improvement initiative

Background: Acute ischemic stroke therapy is time sensitive, and optimum treatment is missed due to pre-hospital and/or in-hospital delay. Materials and Methods: A prospective observational (before and after) study was conducted for 1 year. The study period was defined as phase-I or pre-education phase, phase-II or immediate post-education phase, and phase-III or delayed post-education phase, with each phase lasting for 4months. All consecutive stroke patients presenting within 12 hours of stroke onset were enrolled. Baseline and outcome data including acute stroke care quality matrices and functional outcomes were collected. Results: A total of 264 patients were enrolled. All acute stroke care quality matrices improved significantly (P <= 0.01) with a median door to imaging time (DTI) of 114, 35, and 47 minutes in the three phases consecutively. In phase-II, proportions of patients imaged within 25 minutes of arrival increased by 35%. Mean door to needle (DTN) time were 142 +/- 49.7,63.7 +/- 25.1, and 83.9 +/- 38.1 minutes in the three consecutive phases. Patients with DTN < 60 minutes of arrival increased by 63%. Modified Rankin score (mRS) at 3 months improved significantly in all ischemic stroke patients (P = 0.04) and patients with mRS of 0-2 increased by 22%. Conclusions: Stroke education to emergency department (ED) staff is an effective method to improve acute stroke care.