Title
Author
DOI
Article Type
Special Issue
Volume
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Reorganisation of stroke care in prehospital emergency medical services: results through transformative learning
1Department of Emergency Medicine, Kanta-Häme Central Hospital, Ahvenistontie 20, FI-13530 Hämeenlinna, Finland
2Faculty of Education and Culture, Tampere University, FI-33014 University of Tampere, Finland
3Emergency Medical Services of Kanta-Häme, Kutalantie 1 B, FI-13210 Hämeenlinna, Finland
4Faculty of Medicine and Health Technology, Tampere University, FI-33014 Tampere University, Finland
DOI: 10.22514/sv.2021.054 Vol.17,Issue 3,May 2021 pp.151-157
Submitted: 30 December 2020 Accepted: 08 February 2021
Published: 08 May 2021
*Corresponding Author(s): Lauri Antila E-mail: Lauri.Antila@khshp.fi
Background: Rapid recanalisation is important when treating ischaemic stroke patients. In Finland, the reorganisation of the prehospital emergency medical system and the establishment of emergency medicine as an independent speciality occurred some years ago. These reforms offered the opportunity to develop new prehospital and in-hospital pathways for stroke patients.
Methods: In this retrospective study, we examined the immediate impact of implementing a new operating model in prehospital stroke care. We introduced a modified “load-and-go” model using a transformative learning process. We observed the immediate effects of the reorganisation by comparing prehospital time intervals three months before and three months after the reorganisation.
Results: The new operating model was implemented using a transformative learning process. There was an immediate reduction of 35.1% from 21.4 to 13.9 minutes (P < 0.001) in the median on-scene time and of 18.2% from 52.7 to 43.1 minutes (P < 0.05) in the median total time, i.e. the time interval between the alarm from the dispatch centre to patient hand-over to ED.
Conclusion: By using a transformative learning process in implementing a modified load-and-go operation model in the EMS, we could immediately reduce median on-scene time and median total time in the treatment of acute stroke patients.
Acute ischaemic stroke; Emergency medicine; Thrombolysis; Reorganisation; Prehos-pital emergency medical system
Lauri Antila,Anne Jyrkiäinen,Lasse Hakala,Seppo Uusinarkaus,Juhani Tavasti,Ari Palomäki. Reorganisation of stroke care in prehospital emergency medical services: results through transformative learning. Signa Vitae. 2021. 17(3);151-157.
[1] Meretoja A, Strbian D, Mustanoja S, Tatlisumak T, Lindsberg PJ, Kaste M. Reducing in-hospital delay to 20 minutes in stroke thrombolysis. Neurology. 2012; 79: 306-313.
[2] Meretoja A, Keshtkaran M, Saver JL, Tatlisumak T, Parsons MW, Kaste M, et al. Stroke thrombolysis: save a minute, save a day. Stroke. 2014; 45: 1053-1058.
[3] Naskali J, Palomäki A, Harjola VP, Hällberg V, Innamaa T, Rautava VP. Emergency medicine in Finland: first year experiences of specialist training. Journal of Academic Emergency Medicine. 2014; 13: 26-29.
[4] Baldursson J, Björnsson HM, Palomäki A. Emergency medicine for 25 Years in Iceland - history of the specialty in a nutshell. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2018; 26: 1.
[5] Heikkilä I, Kuusisto H, Stolberg A, Palomäki A. Stroke thrombolysis given by emergency physicians cuts in-hospital delays significantly immediately after implementing a new treatment protocol. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2016; 24: 46.
[6] Heikkilä I, Kuusisto H, Holmberg M, Palomäki A. Fast operating model for treating acute ischemic stroke by emergency physicians. Annals of Emergency Medicine. 2019; 73: 105-112.
[7] Kim YS, Park SS, Bae HJ, Cho AH, Cho YJ, Han MK, et al. Stroke awareness decreases prehospital delay after acute ischemic stroke in Korea. BMC Neurology. 2011; 11: 2.
[8] Mezirow J. Transformative learning: theory to practice. New Directions for Adult and Continuing Education. 1997; 1997: 5-12.
[9] Dewey J. How we think. Boston: D.C. Heath & Co. 1910.
[10] Mezirow J. Learning as transformation: critical perspectives on a theory in progress. The Jossey-Bass Higher and Adult Education Series. San Francisco: Jossey-Bass Publishers. 2000.
[11] Tsimane TA, Downing C. Transformative learning in nursing education: a concept analysis. International Journal of Nursing Sciences. 2019; 7: 91-98.
[12] Kerins J, Smith SE, Phillips EC, Clarke B, Hamilton AL, Tallentire VR. Exploring transformative learning when developing medical students’ non-technical skills. Medical Education. 2020; 54: 264-274.
[13] Foshee CM, Mehdi A, Bierer SB, Traboulsi EI, Isaacson JH, Spencer A, et al. A professionalism curricular model to promote transformative learning among residents. Journal of Graduate Medical Education. 2017; 9: 351-356.
[14] Nor AM, McAllister C, Louw SJ, Dyker AG, Davis M, Jenkinson D, et al. Agreement between ambulance paramedic- and physician-recorded neurological signs with Face Arm Speech Test (FAST) in acute stroke patients. Stroke. 2004; 35: 1355-1359.
[15] Wu Y, Tsai T, Huang C. Contraversive shift of conjugate eye deviation in hemispheric stroke indicates emerging mass effect. Journal of Clinical Neuroscience. 2011; 18: 1276-1278.
[16] Campbell AR. Building a culture of excellence from the ground up. Radiology Management. 2013; 35: 14-18.
[17] Dawson S, King L, Grantham H. Review article: Improving the hospital
clinical handover between paramedics and emergency department staff in the deteriorating patient. Emergency Medicine Australasia. 2013; 25: 393-405.
[18] Yanagida T, Fujimoto S, Inoue T, Suzuki S. Prehospital delay and stroke-related symptoms. Internal Medicine. 2015; 54: 171-177.
[19] Kim DH, Nah HW, Park HS, Choi JH, Kang MJ, Huh JT, et al. Impact of prehospital intervention on delay time to thrombolytic therapy in a stroke center with a systemized stroke code program. Journal of Stroke and Cerebrovascular Diseases. 2016; 25: 1665-1670.
[20] Lin CB, Peterson ED, Smith EE, Saver JL, Liang L, Xian Y, et al. Emergency medical service hospital prenotification is associated with improved evaluation and treatment of acute ischemic stroke. Circulation: Cardiovascular Quality and Outcomes. 2012; 5: 514-522.
[21] McKinney JS, Mylavarapu K, Lane J, Roberts V, Ohman-Strickland P, Merlin MA. Hospital prenotification of stroke patients by emergency medical services improves stroke time targets. Journal of Stroke and Cerebrovascular Diseases. 2013; 22: 113-118.
[22] Oostema JA, Nasiri M, Chassee T, Reeves MJ. The quality of prehospital ischemic stroke care: compliance with guidelines and impact on in-hospital stroke response. Journal of Stroke and Cerebrovascular Diseases. 2014; 23: 2773-2779.
[23] Simonsen SA, Andresen M, Michelsen L, Viereck S, Lippert FK, Iversen HK. Evaluation of pre-hospital transport time of stroke patients to thrombolytic treatment. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2014; 22: 65.
[24] Puolakka T, Kuisma M, Länkimäki S, Puolakka J, Hallikainen J, Rantanen K, et al. Cutting the prehospital on-scene time of stroke thrombolysis in Helsinki: a prospective interventional study. Stroke. 2016; 47: 3038-3040.
[25] Drenck N, Viereck S, Bækgaard JS, Christensen KB, Lippert F, Folke F. Pre-hospital management of acute stroke patients eligible for thrombolysis - an evaluation of ambulance on-scene time. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2019; 27: 3.
[26] Varjoranta T, Raatiniemi L, Majamaa K, Martikainen M, Liisanantti JH. Prehospital and hospital delays for stroke patients treated with thrombolysis: a retrospective study from mixed rural-urban area in Northern Finland. Australasian Emergency Care. 2019; 22: 76-80.
[27] Price CI, Shaw L, Islam S, Javanbakht M, Watkins A, McMeekin P, et al. Effect of an enhanced paramedic acute stroke treatment assessment on thrombolysis delivery during emergency stroke care: a cluster randomized clinical trial. JAMA Neurology. 2020; 77: 840-848.
[28] Wireklint Sundström B, Herlitz J, Hansson PO, Brink P. Comparison of the university hospital and county hospitals in western Sweden to identify potential weak links in the early chain of care for acute stroke: results of an observational study. BMJ Open. 2015; 5: e008228.
[29] Park HA, Ahn KO, Shin SD, Cha WC, Ro YS. The Effect of emergency medical service use and inter-hospital transfer on prehospital delay among ischemic stroke patients: a multicenter observational study. Journal of Korean Medical Science. 2016; 31: 139-146.
[30] Oostema JA, Chassee T, Baer W, Edberg A, Reeves MJ. Brief educational intervention improves emergency medical services stroke recognition. Stroke. 2019; 50: 1193-1200.
[31] Li T, Cushman JT, Shah MN, Kelly AG, Rich DQ, Jones CMC. Pre-hospital time intervals and management of ischemic stroke patients. The American Journal of Emergency Medicine. 2020; S0735-6757(20)30079-6.
[32] Puolakka T, Väyrynen T, Erkkilä E, Kuisma M. Fire engine support and on-scene time in prehospital stroke care - a prospective observational study. Prehospital and Disaster Medicine. 2016; 31: 278-281.
[33] Lehtonen H, Lukkarinen T, Kämäräinen V, Rautava VP, Parvinen P, Palomäki A. Improving emergency department capacity efficiency. Signa Vitae. 2016; 12: 52-57.
[34] Rautava V, Palomäki E, Innamaa T, Perttu M, Lehto P, Palomäki A. Improvement in self-reported confidence in nurses’ professional skills in the emergency department. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2013; 21: 16.
[35] Berglund A, Svensson L, Wahlgren N, von Euler M. Face Arm Speech Time Test use in the prehospital setting, better in the ambulance than in the emergency medical communication center. Cerebrovascular Diseases. 2014; 37: 212-216.
[36] Meretoja A, Kaste M. Pre- and in-hospital intersection of stroke care. Annals of the New York Academy of Sciences. 2012; 1268: 145-151.
[37] Massé J, Dupéré S, Martin É, Lévesque MC. Transformative medical education: must community-based traineeship experiences be part of the curriculum? A qualitative study. International Journal for Equity in Health. 2020; 19: 94.
[38] Pieri M, Bellomo R, Zangrillo A, Winterton D, Landoni G. Evolving from past to future: facilitating SMART research. Signa Vitae. 2016; 12: 14-18.
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