Hospital Predictions: Changes in Acute Stroke Care

ESO Staff

Every year, ESO’s experts to make predictions about what the year ahead will most likely bring for the hospital, fire, and EMS industries. These prediction publications also include recommended action items for each prediction presented, so that industry leaders may be better prepared for the changes to come.

Continued Changes: Approach to Acute Stroke

In the 2019 Hospital Predictions, one of the top predictions for hospitals is a continued change in the approach to acute stroke. In 2018, new information about stroke response times had a major ripple effect for prehospital care through the emergency departments to definitive care.

While there has been some difficulty gaining consensus based on these data points, we believe that 2019 will see the medical community reach agreement on the fundamentals of care for acute stroke. This will include definitive, consistent classification of stroke centers, allowing EMS agencies to make better transport decisions. Ultimately, decisions around transport will likely be made with reliable hospital outcome information.

The Need for More Complete Screening

In a recent webinar, ESO Solutions Chief Medical Officer Brent Myers, MD, MPH, FACEP, FAEMS, explained that the assessment and treatment of acute stroke patients appears to be on the cusp of a major shift. This is similar to that experienced in recent years for the screening and care of cardiac patients that has changed how patients are screened, where they were transported, and how often they survive. These changes promise to be especially impactful to professionals in pre-hospital and emergency department care, as more information is emerging based on the timeliness of appropriate care and patient outcomes.

New data is suggesting that a full, accurate assessment on a potential stroke patient is more important than ever in dictating the next steps that providers should take when faced with a stroke situation. However, due to pervading belief that the faster a patient received stroke care, the better the chances for a positive outcome, most EMS technicians have been trained to jump into action as soon as the first positive credential for stroke were met. This resulted in more than 50% of stroke patients not receiving a full, complete pre-hospital stroke screen.

However, by implementing easier-to-use, progressive stroke screening tools and increasing awareness of the best types of care for various types of stroke, EMS technicians can deliver the patient to the best treatment facility with a more complete assessment, leading ideally to a more effective treatment by physicians. Additionally, optimal treatment time windows appear to be shifting, based on the type of stroke, potentially giving providers more time to administer the proper care for optimized outcomes.

The Right Treatment at the Right Time

As more is learned about acute strokes, more specialized approaches and protocols are being developed. For example, in the 2018 DAWN study, patients with acute stroke who had last been known to be well 6 to 24 hours earlier, and who had a mismatch between clinical deficit and infarct, saw better outcomes at 90 days after receiving a thrombectomy plus standard care, than with standard care alone.

Many EMS agencies today are working to identify local transport destinations that can provide the appropriate levels of specialized stroke care for improved outcomes. And in all cases, complete patient records that are easily handed off to receiving locations are undoubtedly more efficient and helpful in treatment.

Recommended Actions

You can better prepare your hospital for these changing protocols standards by taking the following recommended actions.

  • Stay abreast of guidelines and understand what changes impact how your hospital should manage care. Watch ESO’s Mission Possible: Acute Stroke Care webinar to gain a better understanding of how these shifts in guidelines can change your approach to stroke.
  • Be prepared to modify stroke screens and hospital destination guides as more position statements are promulgated and consensus becomes more crystalized.

To read the additional predictions for hospitals in 2019 – including tighter communication between EMS and hospital EDs, a greater role for mobile and smartphone technology, and more non-traditional acquisitions and mergers – download the full 2019 Hospital Predictions publication now.

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