Mobile stroke unit in the UK healthcare system: avoidance of unnecessary accident and emergency admissions

TY - JOUR

T1 - Mobile stroke unit in the UK healthcare system

T2 - avoidance of unnecessary accident and emergency admissions

AU - Phillips, Daniel

AU - Grunwald, Iris Q

AU - Walter, Silke

AU - Faßbender, Klaus

PY - 2021/3/1

Y1 - 2021/3/1

N2 - Aims: The aim of the study was to explore the benefit of a mobile stroke unit (MSU) in the UK National Health Service (NHS) for reduction of hospital admissions.Methods: Prospective cohort audit observation with dispatch of the MSU in the East of England Ambulance Service was conducted. Emergency patients categorised as code stroke and headache were included from 5 June to 18 December 2018. Rate of avoided admission to the accident and emergency (A&E) department, rate of admission directly to target ward and stroke management metrics were assessed.Results: In 116 MSU-treated patients, the following diagnoses were made: acute stroke, n = 33 (28.4%); transient ischaemic attacks, n = 13 (11.2%); stroke mimics, n = 32 (27.6%); and other conditions, n = 38 (32.8%). Pre-hospital thrombolysis was administered to eight of 28 (28.6%) ischaemic stroke patients. Pre-hospital diagnosis avoided hospital admission for 29 (25.0%) patients. As hospital treatment was indicated, 35 (30.2%) patients were directly triaged to the stroke unit, one patient (0.9%) even directly to the catheter laboratory. Thus, only 50 (43.1%) patients required transfer to the A&E department. Moreover, the MSU enabled thrombolysis with a median dispatch-to-needle time of 42 mins (interquartile range, 40-60).Conclusion: This first deployment of an MSU in the UK NHS demonstrated improved triage decision-making for or against hospital admission and admission to the appropriate target ward, thereby reducing pressure on strained A&E departments.

AB - Aims: The aim of the study was to explore the benefit of a mobile stroke unit (MSU) in the UK National Health Service (NHS) for reduction of hospital admissions.Methods: Prospective cohort audit observation with dispatch of the MSU in the East of England Ambulance Service was conducted. Emergency patients categorised as code stroke and headache were included from 5 June to 18 December 2018. Rate of avoided admission to the accident and emergency (A&E) department, rate of admission directly to target ward and stroke management metrics were assessed.Results: In 116 MSU-treated patients, the following diagnoses were made: acute stroke, n = 33 (28.4%); transient ischaemic attacks, n = 13 (11.2%); stroke mimics, n = 32 (27.6%); and other conditions, n = 38 (32.8%). Pre-hospital thrombolysis was administered to eight of 28 (28.6%) ischaemic stroke patients. Pre-hospital diagnosis avoided hospital admission for 29 (25.0%) patients. As hospital treatment was indicated, 35 (30.2%) patients were directly triaged to the stroke unit, one patient (0.9%) even directly to the catheter laboratory. Thus, only 50 (43.1%) patients required transfer to the A&E department. Moreover, the MSU enabled thrombolysis with a median dispatch-to-needle time of 42 mins (interquartile range, 40-60).Conclusion: This first deployment of an MSU in the UK NHS demonstrated improved triage decision-making for or against hospital admission and admission to the appropriate target ward, thereby reducing pressure on strained A&E departments.

U2 - 10.29045/14784726.2021.3.5.4.64

DO - 10.29045/14784726.2021.3.5.4.64

M3 - Article

C2 - 34421380

SN - 1478-4726

VL - 5

SP - 64

JO - British paramedic journal

JF - British paramedic journal

IS - 4

ER -