Time delays in accessing stroke care in the emergency department

Objective: To delineate components of delay within the hospital ED for pati ents presenting with symptoms of stroke. Methods: A prospective registry of patients presenting to the ED with signs or symptoms of stroke was establi shed at a university hospital from July 1995 to March 1996. The ED ar rival time, time to being seen by an emergency physician (EP), time to CT scan, and time to neurology consultation were obtained by medical record review. Results: The median delay (interquartile range) from ED arrival to being se en by an EP for the 170 eligible subjects was 0.42 (0.20-0.75) hours. The m edian delay to CT scan was 1.88 hours (1.25-2.67) and the median delay to n eurology consultation was 2.42 hours (1.50-3.48). Age, race, sex, and hospi tal discharge diagnosis had little influence on delay. Subjects arriving by emergency medical services (EMS) had a significantly shorter time to being seen by an EP (0.33 vs 0.50 hours) when compared with those who arrived by other means. Time to CT scan was shorter by 0.5 hours for patients arrivin g by EMS as well. These differences persisted when stratified by out-of-hos pital delay times. Conclusions: These data suggest that arriving by EMS is associated with shorter times to being seen by an EP and receiving a CT sca n. The influence of EMS on delays associated with rapid medical care of str oke patients reaches beyond the out-of-hospital transport phase.