A geographic information system analysis of the impact of a statewide acute stroke emergency medical services routing protocol on community hospital bypass.
BACKGROUND
Our goal was to determine if a statewide Emergency Medical Services (EMSs) Stroke Triage and Destination Plan (STDP), specifying bypass of hospitals unable to routinely treat stroke patients with thrombolytics (community hospitals), changed bypass frequency of those hospitals.


METHODS
Using a statewide EMS database, we identified stroke patients eligible for community hospital bypass and compared bypass frequency 1-year before and after STDP implementation.


RESULTS
Symptom onset time was missing for 48% of pre-STDP (n = 2385) and 29% of post-STDP (n = 1612) cases. Of the remaining cases with geocodable scene addresses, 58% (1301) in the pre-STDP group and 61% (2,078) in the post-STDP group were ineligible for bypass, because a community hospital was not the closest hospital to the stroke event location. Because of missing data records for some EMS agencies in 1 or both study periods, we included EMS agencies from only 49 of 100 North Carolina counties in our analysis. Additionally, we found conflicting hospital classifications by different EMS agencies for 35% of all hospitals (n = 38 of 108). Given these limitations, we found similar community hospital bypass rates before and after STDP implementation (64%, n = 332 of 520 vs. 63%, n = 345 of 552; P = .65).


CONCLUSIONS
Missing symptom duration time and data records in our state's EMS data system, along with conflicting hospital classifications between EMS agencies limit the ability to study statewide stroke routing protocols. Bypass policies may apply to a minority of patients because a community hospital is not the closest hospital to most stroke events. Given these limitations, we found no difference in community hospital bypass rates after implementation of the STDP.
['Asimos|Andrew W|AW|', 'Ward|Shana|S|', 'Brice|Jane H|JH|', 'Enright|Dianne|D|', 'Rosamond|Wayne D|WD|', 'Goldstein|Larry B|LB|', 'Studnek|Jonathan|J|']
D000368:Aged D000369:Aged, 80 and over D002391:Catchment Area, Health D016208:Databases, Factual D004632:Emergency Medical Services D005260:Female D040362:Geographic Information Systems D006297:Health Services Accessibility D006764:Hospitals, Community D006801:Humans D008297:Male D008875:Middle Aged D009657:North Carolina D015397:Program Evaluation D012040:Regional Health Planning D020521:Stroke D015912:Thrombolytic Therapy D061665:Time-to-Treatment D014187:Transportation of Patients D016896:Treatment Outcome D014218:Triage
stroke protocols bypass EMS transport