Ian Mosley1, Julia Morphet, Kelli Innes, George Braitberg. 1. Monash University, Faculty of Medicine Nursing and Health Sciences, School of Nursing and Midwifery, Melbourne, Australia. ian.mosley@monash.edu
Abstract
BACKGROUND: Rapid care protocols developed to reduce in-hospital delay times in the assessment of acute stroke patients are now common in Emergency Departments. Correct triage identification and prioritisation is vital to instigate this process and increase the eligibility of patients for acute stroke treatments. OBJECTIVE: We set out to examine triage assessments of acute stroke patients and investigate factors associated with the instigation of rapid care protocols (allocation of triage category 1 or 2) for acute stroke patients presenting within 2 h of symptom onset. METHODS: A retrospective assessment of emergency department records was undertaken for stroke patients presenting to three hospitals in Melbourne over six months in 2010. RESULTS: 798 patients were included in the study. Among acute stroke patients who presented within 2 h (n=185), 173 (94%) were identified as stroke at triage with 10 cases identified as "altered conscious state". In all cases not identified as stroke the patient was diagnosed with intracerebral haemorrhage. 132 cases (71%) were allocated a triage category 1 or 2. Facial weakness (p=0.002) and presentation to Monash Medical Centre (p=<0.001), were significantly associated with triage category 1 or 2. CONCLUSION: Virtually all acute stroke patients were identified at triage, however 30% were not allocated an urgent triage category (1 or 2). Further education strategies may be required to develop awareness of rapid care protocols for acute stroke patients among triage nurses and ensure the uniform application of Acute Stroke Guidelines and local rapid care pathways.
BACKGROUND: Rapid care protocols developed to reduce in-hospital delay times in the assessment of acute strokepatients are now common in Emergency Departments. Correct triage identification and prioritisation is vital to instigate this process and increase the eligibility of patients for acute stroke treatments. OBJECTIVE: We set out to examine triage assessments of acute strokepatients and investigate factors associated with the instigation of rapid care protocols (allocation of triage category 1 or 2) for acute strokepatients presenting within 2 h of symptom onset. METHODS: A retrospective assessment of emergency department records was undertaken for strokepatients presenting to three hospitals in Melbourne over six months in 2010. RESULTS: 798 patients were included in the study. Among acute strokepatients who presented within 2 h (n=185), 173 (94%) were identified as stroke at triage with 10 cases identified as "altered conscious state". In all cases not identified as stroke the patient was diagnosed with intracerebral haemorrhage. 132 cases (71%) were allocated a triage category 1 or 2. Facial weakness (p=0.002) and presentation to Monash Medical Centre (p=<0.001), were significantly associated with triage category 1 or 2. CONCLUSION: Virtually all acute strokepatients were identified at triage, however 30% were not allocated an urgent triage category (1 or 2). Further education strategies may be required to develop awareness of rapid care protocols for acute strokepatients among triage nurses and ensure the uniform application of Acute Stroke Guidelines and local rapid care pathways.
Authors: Louise E Craig; Natalie Taylor; Rohan Grimley; Dominique A Cadilhac; Elizabeth McInnes; Rosemary Phillips; Simeon Dale; Denise O'Connor; Chris Levi; Mark Fitzgerald; Julie Considine; Jeremy M Grimshaw; Richard Gerraty; N Wah Cheung; Jeanette Ward; Sandy Middleton Journal: Implement Sci Date: 2017-07-17 Impact factor: 7.327
Authors: Sandy Middleton; Chris Levi; Simeon Dale; N Wah Cheung; Elizabeth McInnes; Julie Considine; Catherine D'Este; Dominique A Cadilhac; Jeremy Grimshaw; Richard Gerraty; Louise Craig; Verena Schadewaldt; Patrick McElduff; Mark Fitzgerald; Clare Quinn; Greg Cadigan; Sonia Denisenko; Mark Longworth; Jeanette Ward Journal: Implement Sci Date: 2016-10-18 Impact factor: 7.327