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Industry Insight: EMS Rates of Complete Stroke Assessments

ESO Staff

At the end of 2018, ESO released its second annual EMS Index, an in-depth report covering key data points and trends in the EMS industry, based on more than 7.58 million patient encounters from 2018.

One of the key metrics covered was rate of completed stroke assessments, a hot topic for the industry as new best practices are currently being developed and shared within the industry. Stroke continues to be one of the United States’ leading causes of long-term disability and death, representing more than $34 billion each year in medical expenses and lost wages, and 140,000 deaths.

The stroke assessment and documentation metric examines what proportion of 9-1-1 EMS patient care records (excluding inter-facility transfers and other types of encounters) included documentation of a complete stroke screen when the EMS provider’s primary impression indicated stroke. Current industry insight is suggesting that a full EMS stroke assessment, now more than ever, can make the difference in a successful or not-so-successful outcome.

Existing Barriers to Full Stroke Screens

In the past, the prevailing belief – “the faster the stroke treatment, the better the outcome” – often led EMTs to jump to action as soon as one stroke criteria was met, citing a small treatment window for success. Today, however, a more complete assessment seems to be the key in selecting the most effective treatment; specifically, the option to transport the patient to the appropriate facility that can offer newer treatments like thrombectomies. Additionally, the stroke treatment window seems to be shifting as well, giving EMTs and physicians more time to administer the best treatment plan with little impact on outcome.

To further complicate matters, strokes typically represent only a small portion of EMS encounters (around only 1.1%). EMS professionals are still expected to screen for specialized symptoms and details that not only record the impression of stroke, but the severity as well. The good news is that today’s industry-leading, in-bus ePCR software tools now offer customizable screening forms that quickly walk an EMT through the appropriate assessment steps for stroke. This makes it not only more likely that a patient will receive a complete screen, but that complete records are ready for hand off at the receiving facility.

A Promising Trend

When ESO first examined the stroke assessment metric in its 2018 EMS Index, the rate of patients receiving a full, complete assessment was hovering at only around 50%. By the end of 2018, however, the rate was rising significantly, up to 65%. In looking at this same data from the first half of 2019 (from an additional 3.8 million patient records), the ESO EMS Index Mid-Year Update reported an even greater increase, up to 69% of stroke patients receiving a full, complete assessment.

While there is still room for improvement, this uptick demonstrates the commitment of EMS professionals to assist with early stroke detection, as well as to evaluate the severity of a stroke. ESO is currently using pre-hospital data in combination with hospital outcomes in its research database to evaluate the ability of various stroke screens to predict the presence of LVO, and hopes to release these results in the coming months

To learn more about the stroke assessment metric and the five other core data points download the 2019 EMS Index now, as well as the Mid-Year Index Update for the most current metrics.

To hear more about the ongoing changes in stroke assessment and how it will affect the industry as a whole, listen to the webinar, Mission Possible: Acute Stroke Care, on-demand by ESO Solutions Chief Medical Officer Brent Myers, MD, MPH, FACEP, FAEMS.

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