Emergency department companions of stroke patients: implications on quality of care

Abstract

Acute care of stroke victims largely relies on the rapid identification and timely clinical and radiological assessment. We evaluated the effect of the number of patient companions on the efficiency of the diagnostic process in the emergency department (ED).Consecutive stroke patients admitted to the ED between August 2011 and October 2012 were evaluated. Clinical, epidemiological, and timeline data (symptoms onset, ED arrival, computed tomography [CT] scanning, and recombinant tissue plasminogen activator infusion), as well as the number of accompanying persons in the ED were prospectively recorded. We used multivariate Poisson log linear models to analyze the association of number of companions adjusted and door-to-CT times and logistic regression for the analysis of the successful identification of stroke patient by ED triage nurse.Out of a total of 724 stroke patients admitted, data regarding number of ED companions were available for 610 (84.3%) patients. Number of companions was associated with higher National Institute of Health Stroke Scale and speech disturbances. It was found to be independently associated with shorter time to CT scanning adjusted for the stroke severity, sex, and speech disturbances (no companions as a reference group, relative risks 0.82, 0.73, and 0.70 for 1, 2, and ≥3 companions, respectively, all P < 0.001). Similarly, number of companions was associated with higher rates of stroke recognition by the triage nurse adjusted for covariates (odds ratios 2.11, 2.62, and 4.11, respectively, all P < 0.05).Our findings suggest that the family members and other companions could serve as facilitators of faster and more effective ED management of stroke patients, possibly improving their outcome.

FIGURE 1

Time (minutes) from ED arrival to beginning of CT scanning according to number of ED companions (median, IQ range). CT = computed tomography, ED = emergency department, IQ = interquartile.

FIGURE 2

Logistic regression for the recognition of stroke patient by triage nurse (odds ratio and 95% confidence intervals). Model adjusted for escorts, NIHSS, and speech disturbances. NIHSS = National Institute of Health Stroke Scale.