Implementation of Community Stroke Education and Awareness Efforts in Reducing Pre-hospital Delays and Increasing t-PA Eligibility
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Lueth, Kassie
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2017-05-14
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Objective: The purpose of this program development was to determine if community stroke education and awareness efforts were effective in reducing pre-hospital delays, through early recognition of stroke symptoms, EMS activation, and ultimately, increase t-PA eligibility for those individuals admitted for an acute ischemic stroke.|Methods: This study used a quasi-experimental design. Direct community education interventions were implemented to staff and residents of 3 retirement and 4 assisted living facilities. An oral/PowerPoint stroke presentation was provided, with emphasis on risk factors, symptoms and recognition, EMS activation, and treatment. A stroke knowledge assessment tool was used to evaluate partaker's knowledge of these components, immediately preceding and succeeding the presentation. The initial survey also included demographic data, as well as stroke history and exposure. Stroke awareness means were indirectly distributed to 21 local pharmacies, 11 primary care clinics, as well as to the facilities and participants of the education sessions, utilizing ACT FAST materials. Clinical efficacy of these aims were evaluated through hospital data collection from this Southwestern Iowa community's Primary Stroke Center. Data included door-to-needle times, transportation mode, and t-PA utilization rates, for those admitted with confirmed ischemic stroke prior to, and throughout project implementation and completion.|Results: The educational intervention study encompassed a total of 59 participants between 22 and 83 years of age (M=70.4). Prior to education intervention, most persons accurately identified the stroke risk factors of smoking (88.1%), and high blood pressure (83%), though only 11% could identify all five. Moreover, 60% of participants could identify at least 1 symptom of stroke, with sudden difficulty speaking being the most readily identified (91.3%), yet <10% could identify all. Most participants (44.1%), reported they would call 911 right away at stroke symptom onset, despite 62.7% believing it was true, that if they experienced symptoms, but they resolved quickly, they did not need seek urgent medical help. More than half of all subjects (55.9%) were unsure if treatment was available for stroke, and only 11.8% were able to correctly identify the time frame for receiving thrombolytics. Post-educational intervention data, showed statistically significant progress in identifying all stroke risk factors (61.5%), and all stroke symptoms (69.2%). Correspondingly, all respondents (100%) noted they would call 911 right away for stroke symptoms as well as accurately recognizing treatment availability (100%), and 87.2% correctly identified the recommended time-frame of t-PA therapy. Inferred successive hospital data, congruently demonstrated favorable improvement in t-PA utilization rates from 6% to 18%, increased EMS dispatch use from 48% to 52%, and reduced door-to-needle times (M=60.6 minutes to M=52 minutes).|Conclusion: This study demonstrates that a single educational session can improve short-term knowledge of stroke symptoms. This stroke awareness and education program demonstrated inferred favorable improvements in hospital data's t-PA utilization, door-to-needle times, and appropriate EMS transport. These findings suggest that community stroke awareness and education employments may have important implications for reducing stroke related disability, via reducing pre-hospital delays, and increasing the proportion of patients eligible for t-PA.|Key Words: Community, stroke, education, symptoms, awareness, knowledge, impact, pre-hospital delays, EMS activation, t-PA, door-to-needle time.
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