Burrow, Emma

Finch, Tracey

McClelland, Graham

Price, C.

Shaw, L.

Stagg, Hayley

English

Ambulance Research Repository

Reducing ambulance on-scene times for suspected stroke through an evidence-based training package: an interim analysisAuthors G. McClelland1,2, E. Burrow2, H. Stagg2, L. Shaw1, T. Finch3, C. Price11 Newcastle University, United Kingdom; 2 North East Ambulance Service NHS Foundation Trust, United Kingdom; 3 Northumbria University, United KingdomBackground and aimsPrehospital stroke care guidelines emphasize rapid assessment and transportation to improve treatment outcomes. Ambulance on-scene times (OST) for UK stroke patients have increased in recent years1. Training to reduce OST was developed in one ambulance service based upon literature review2, clinical data3 and interviews with paramedics. It aimed to minimise on-scene delays by discouraging: 1) unnecessary advanced clinical assessment; 2) 12-lead ECG recordings; and 3) intravenous (IV) cannulation. We report the training impact on OST and clinician feedback on the training.  MethodsTraining was delivered to 93% (1377/1475) of North East Ambulance Service (NEAS) ambulance clinicians via an online video April to September 2022. Routinely collected data were used to compare OST, patient characteristics and ambulance assessment content before and after training as a service evaluation (VOWELS I). Clinicians were asked to complete a feedback survey three months post training (VOWELS II). Results This data is an interim analysis as the aim is to report 12 months complete data. Data are reported on 3,132 consecutive suspected stroke patients from 93 days pre-training (01/12/21 to 03/03/22) and 83 days post-training (12/09/22 to 03/12/22). There was a statistically significant 2-minute (6%) reduction in OST. Sixty-eight clinicians (5%) completed the feedback survey. Most respondents found the video relevant (96%, n=68), useful (96%, n=68) and engaging (84%, n=68) and reported that it improved their stroke knowledge (87%, n=68). Respondents reported they had changed practice around cannulation (51%, n=65), advanced assessments (48%, n=65) and ECGs (43%, n=65). Mostly positive reactions from crewmates and hospital staff were reported by respondents. References1. Haworth D, McClelland G. (2019). Call to hospital times for suspected stroke patients in the North East of England: a service evaluation. British Paramedic Journal. 4(2): 31-36. https://doi.org/10.29045/14784726.2019.09.4.2.312. McClelland G, Hepburn S, Finch T, Price C. (2022). How do interventions to improve the efficiency of acute stroke care affect prehospital times? A systematic review and narrative synthesis. BMC Emerg Med 22, 153. https://doi.org/10.1186/s12873-022-00713-63. McClelland G, Burrow E, Alton A, Shaw L, Finch T, Price C. (2023). What factors contribute towards ambulance on-scene times for suspected stroke patients? An observational study. European Stroke Journal. https://doi:10.1177/23969873231163290Conclusions. In this interim analysis OST was reduced and two out of three behaviours targeted during training were performed less often. Clinician feedback on the training was largely positive although a preference for face-to-face delivery over online training was expressed. Advanced clinical assessments aren’t documented in the same standard fashion as ECGs and IV cannulation which may explain the low numbers reported. Further data will be collected to verify these interim results and further research is needed to show how this improvement can be maximised and sustained. Lead author contact detailsDr Graham McClellandParamedic Research Fellow and Visiting Clinical ResearcherGraham.mcclelland@neas.nhs.ukTwitter: @mcclgFundingThis study was funded by a Stroke Association fellowship grant (TSA PDF 20\100001), approved by the Health Research Authority (VOWELS II, Ref 22/HRA/1187), received ethical approval from Newcastle University (VOWELS II, Ref: 18728/2022) and adopted onto the CRN Portfolio.Pre-training Post-training P valueSuspected stroke cases 1670 1462 -Age (years)a 75 (63-84) (n=1669)76 (64-84) 0.176*Gender (male) 50% 50% (n=1417)0.983**On-scene time (minutes)a 35 (27-45) 33 (25-42) <0.001*Advanced clinical assessment 40 (2%) 35 (2%) 1.000**ECG performed 837 (50%) 545 (37%) <0.001**IV cannulation attempted 437 (26%) 322 (22%) 0.007**

Reducing ambulance on-scene times for suspected stroke through an evidence-based training package: an interim analysis

https://amber.openrepository.com/bitstream/20.500.12417/1479/1/Interim%20OST%20Poster%20for%20COP%2023%20v1p.pdf

Reducing ambulance on-scene times for suspected stroke through an evidence-based training package: an interim analysis

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