Emergency and Urgent Care Network: Analysis of the Stroke Care Line According to Care Times and Outcomes
Karina Fonseca de Souza Leite
Ribeirao Preto College of Nursing, University of São Paulo, Brazil.
Rubia Laine de Paula Andrade *
Ribeirao Preto College of Nursing, University of São Paulo, Brazil.
Mariana Gaspar Botelho Funari de Faria
Ribeirao Preto College of Nursing, University of São Paulo, Brazil.
Igor Simões da Silva Isaac
Ribeirao Preto College of Nursing, University of São Paulo, Brazil.
Kamila Santos Ferreira
Ribeirao Preto School of Medicine, University of São Paulo, Brazil.
Juan Lacalle Remigio
Department of Preventive Medicine and Public Health, University of Seville, Spain.
Millene Rodrigues Camilo
Ribeirao Preto School of Medicine, University of São Paulo, Brazil.
Octavio Marques Pontes Neto
Ribeirao Preto School of Medicine, University of São Paulo, Brazil.
Aline Aparecida Monroe
Ribeirao Preto College of Nursing, University of São Paulo, Brazil.
*Author to whom correspondence should be addressed.
Abstract
Background: Given the importance of acute stroke care for public health in terms of its burden and consequences like disability and death, evidence-based practice has directed the development of clinical protocols and operational guidelines to care of the populations affected by this pathology.
Aim: To evaluate the impact of implementing the stroke care line in the Urgency and Emergency Care Network of a large Brazilian municipality.
Methods: This is a retrospective study, conducted between 2014 and 2019 in public health services in Ribeirao Preto, SP, a large municipality of Brazil. Data was collected through secondary sources. A total of 403 patients were included in the study, of which: 172 were treated between 2014 and 2016 and 231 between 2017 and 2019; 118 were served by the mobile pre-hospital care services and 285 by the fixed pre-hospital care services. Data comprise clinical, epidemiological characteristics and severity of cases, as well as stroke care times and outcomes and were analyzed using descriptive techniques, Mann-Whitney and Chi-squared tests.
Results: First care provided by a mobile pre-hospital care unit increased from 16.9% to 38.5%. The service times for people undergoing thrombolysis were shorter in the period from 2017 to 2019 compared to 2014 to 2016 in the door-to-needle, stroke onset-to-call, stroke onset-to-ambulance dispatch and regulation-to-door times. Stroke victims treated first by a mobile (ambulance) unit had shorter care times when compared to those who received care in a fixed unit, except in ambulance dispatch-to-door time. No difference was identified in the percentage of outcomes studied in the period from 2017 to 2019 compared to the period from 2014 to 2016. There was a higher craniectomy occurrence in people treated at home than in those attended in health services. The percentage of unfavorable stroke outcomes increased depending on the case severity.
Conclusion: The care flow organization with defined responsibilities for each care point through the creation of a care line and the use of pre-established protocols reduced pre- and in-hospital care times; however, they did not have a significative influence on the case outcomes.
Keywords: Stroke, emergency medical services, disease management, clinical protocols, thrombolytic therapy