Time to Hospital admission for acute stroke patients.

Abstract

Background: Rapid assessment protocols have been introduced in Emergency Departments (EDs) to streamline processes, reduce times from hospital presentation to medical assessment, CT, treatment and facilitate prompt admission to a stroke unit. in an environment of ambulance ramping, ED overcrowding and bed block we sought to investigate ED length of stay times for acute stroke patients. Aim(s): We set out to examine ED times at multiple time points, investigate total ED times and time from bed request to admission. Method(s): A retrospective assessment of ED records was undertaken for stroke and Transient Ischaemic Attack (TIA) patients presenting to three hospitals in Melbourne over 6 months from September 2011 to January in 2012. Result(s): 782 patients were included in this study. (483 stroke and 299 TIA patients). Among acute stroke patients, 398 were admitted to hospital. The median ED length of stay was 9.1 h (IQ range 5.6- 15.6). Median time from bed request to admission was 5.2 h (IQ range 2.5-11.6). The majority of ED time (57%) was spent waiting for an inpatient bed. Only 6% of patients (n = 23) were admitted within 3 h from hospital presentation. Conclusion(s): The vast majority of acute stroke patients requiring inpatient admission experience extensive delays in the ED waiting for an inpatient bed. ED staff are not trained to deliver inpatient care. Improving admission processes are complex. However patient outcomes may improve if strategies to reduce inpatient admission delays were implemented to support rapid assessment protocols already in place in the ED.