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| Healthline responses to a stroke scenario: urgent need for education |
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August 2007
Investigators from the West Virginia University, USA, found that operators who staff hospital healthlines are often unable to recognize the symptoms of a stroke.
Successful treatment of acute stroke patients is a time-dependent emergency and patients often arrive outside the therapeutic treatment windows. Berry Jarrell and his colleagues evaluated patterns of healthline triage of potential stroke patients and analysed the role that healthlines may have in promoting early presentation.
To test the efficacy and accuracy of the work of healthlines, the investigators acquired phone numbers of healthlines at 82 United States hospitals with neurology residencies. Each healthline was called. The operator was presented with a standardized scripted stroke patient scenario involving a hypothetical 65-year-old man who had had weakness in the left arm and leg and difficulty speaking for about 25 minutes.
Afterwards, the operator was asked to choose one out of four possible responses:
- wait for symptom resolution
- contact a primary care physician
- drive to a local urgent care centre
- call 911 for ambulance transport
The results were shocking: of the 46 participating operators, 10 (22%) recommended that the patient contact a primary care physician, but only 4 of them were able to name one or more signs of stroke. Calls were transferred at least once in 18 cases, and 11 of the 46 operators were not able to name one sign or symptom of stroke. The remaining 36 advised correctly to call 911.
The results of the study indicate that a substantial proportion of stroke patients "are in jeopardy of falling out of the window for therapy," Brett Jarrell and colleagues concluded.
The investigators pointed out that their results reveal an urgent need for improved stroke education of healthline operators. At a minimum, they suggested that operators should be able to recognize elements of the Cincinnati Pre-hospital Stroke Scale: facial droop, arm drift, and slurred speech. Such an educational improvement may result in stroke patients arriving at an emergency department more urgently which is absolutely necessary to improve their outcome.
Reference:
Stroke 2007; 38 (8): 2376–2378.
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