Educating patients after stroke or TIA helps reduce emergency department arrival time

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Providing patients with educational materials or an interactive intervention when they were discharged for stroke or transient ischemic attack (TIA) helped reduce the time they waited before heading to the emergency department following subsequent stroke, TIA or stroke-like symptoms.

During the study, 42 percent of patients arrived in the emergency department within three hours of experiencing a recurrent stroke, TIA or stroke-like symptoms, an increase from 28 percent of patients at baseline. The percentage of patients arriving within three hours was similar between the groups. In this multiethnic, diverse cohort, 51 percent of patients were Hispanic, 17 percent were black and 50 percent were female.

Bernadette Boden-Albala, MPH, DrPH, of the New York University College of Global Public Health, and colleagues published their findings online in Stroke on June 11.

“I don’t think there’s any numbers out there at any hospital reporting close to 50 percent of people arriving within three hours of stroke onset anywhere,” Boden-Albala told Cardiovascular Business. “Our numbers are hanging nationally between at best 20 to maybe 30 percent, and 30 is even very high. It looks like both groups performed well…The big message is that we have to keep educating our populations and especially our high-risk populations that are at very, very high risk of having recurrent events. We have to do a good job of providing them clear and accessible materials.”

In the SWIFT (Stroke Warning Information and Faster Treatment) trial, researchers randomized 1,193 patients who had a stroke or TIA at New York Presbyterian Medical Center to receive educational materials or an interactive intervention. The intervention took place at the hospital and included a PowerPoint presentation and video on stroke survivor preparedness. At baseline, 27 percent of patients arrived at the emergency department within three hours of stroke or TIA.

Boden-Albala said it is common for patients to receive educational materials at discharge, but the materials vary and are not always easily understood or accessible. In this study, patients were told how to prepare in case another event occurred. When patients had recurrent stroke, TIA or symptoms and called 911, Boden-Albala et al also instructed them to mention their symptoms and other details.

“What we found when we were doing our focus groups and trying to design the intervention was that most people would just call and say, ‘Something’s wrong. I don’t know what’s going on,’” Boden-Albala said. “That leads the (911) dispatchers to start asking a series of questions and then prioritizing who gets out to the scene, what kind of ambulance trained personnel get to the scene. By having people feel comfortable discussing the symptoms and stroke, that gets people in (the emergency department) more quickly.”

Within a year of discharge, there were 133 recurrent strokes, 54 TIAs and 37 stroke mimics, which Boden-Albala et al defined as patients who went to the emergency department with stroke symptoms but did not have a stroke or TIA. Recurrent events occurred in 124 patients in the interactive intervention group and 100 patients in the educational materials group.

The researchers found that 40 percent of patients in the interactive intervention group and 46 percent of patients in the educational materials group arrived within three hours.

Boden-Albala said the best predictor of patients getting to the emergency department in time was having family members or friends involved in the intervention and understanding how to identify strokes, TIA or symptoms.

“Our next series of studies is bringing family and friend networks together for both preparedness as well as stroke prevention because that seems to be what’s really important,” she said. “It makes sense. If you’re there with somebody and they’re having a stroke and you’ve been prepared, then you can note that those are the symptoms and call 911 and get them to the emergency room quickly.”