Training emergency services’ dispatchers to recognise stroke: an interrupted time-series analysisReport as inadecuate

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BMC Health Services Research

, 13:318

Quality, performance, safety and outcomes


BackgroundStroke is a time-dependent medical emergency in which early presentation to specialist care reduces death and dependency. Up to 70% of all stroke patients obtain first medical contact from the Emergency Medical Services EMS. Identifying ‘true stroke’ from an EMS call is challenging, with over 50% of strokes being misclassified. The aim of this study was to evaluate the impact of the training package on the recognition of stroke by Emergency Medical Dispatchers EMDs.

MethodsThis study took place in an ambulance service and a hospital in England using an interrupted time-series design. Suspected stroke patients were identified in one week blocks, every three weeks over an 18 month period, during which time the training was implemented. Patients were included if they had a diagnosis of stroke EMS or hospital. The effect of the intervention on the accuracy of dispatch diagnosis was investigated using binomial grouped logistic regression.

ResultsIn the Pre-implementation period EMDs correctly identified 63% of stroke patients; this increased to 80% Post-implementation. This change was significant p=0.003, reflecting an improvement in identifying stroke patients relative to the Pre-implementation period both the During-implementation OR=4.10 95% CI 1.58 to 10.66 and Post-implementation OR=2.30 95% CI 1.07 to 4.92 periods. For patients with a final diagnosis of stroke who had been dispatched as stroke there was a marginally non-significant 2.8 minutes 95% CI −0.2 to 5.9 minutes, p=0.068 reduction between Pre- and Post-implementation periods from call to arrival of the ambulance at scene.

ConclusionsThis is the first study to develop, implement and evaluate the impact of a training package for EMDs with the aim of improving the recognition of stroke. Training led to a significant increase in the proportion of stroke patients dispatched as such by EMDs; a small reduction in time from call to arrival at scene by the ambulance also appeared likely. The training package has been endorsed by the UK Stroke Forum Education and Training, and is free to access on-line.

KeywordsEmergency medical services Emergency medical dispatchers Stroke Recognition training Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-13-318 contains supplementary material, which is available to authorized users.

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Author: Caroline L Watkins - Michael J Leathley - Stephanie P Jones - Gary A Ford - Tom Quinn - Chris J Sutton


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