Deployment of emergency physicians for patients with stroke in the Munsterarea: a cross-sectional study of the quality of medical care in one region

Background and objective: Advances in understanding the pathophysiology and treatment of stroke have led to changed requirements, including the prehos pital phase, for the care of patients with acute stroke. Rapid transport to a regional stroke centre is nowadays considered to be the standard for opt imal quality of care. A retrospective cross-sectional analysis was undertak en in 1996 in the region of the town of Munster to test the quality of medi cal care provided by physicians on emergency call. Patients and methods: 250 of 3001 protocols (8.3%) filled in by emergency c all physicians were selected in which the initial diagnosis of transitory i schaemic attack, stroke or cerebral haemorrhage had been made. Quality of p atient care was assessed according to the following criteria; (1) complete medical treatment (blood sugar, blood pressure, cardiac rhythm and arterial oxygen saturation, including relevant treatment of any abnormality) (2) ac tion time (arrival of emergency doctor within 12 min and arrival at hospita l within 50 min); (3) type of the admission hospital (stroke centre defined as a hospital experienced in the treatment of stroke, with neurological an d medical departments, as well as 24-hour cover for computed cranial tomogr aphy). A summated indicator of >>optimal care<< was used to determine wheth er the three stated criteria were met. Results: Mean age of the stroke patients was 72.3 years. While the above me ntioned quality criteria for the action time were met in 93.5% of patients, only 56.0% were admitted to a stroke centre, and this was significantly mo re often the final destination for patients under the age of 65 years than for older ones (p = 0.049). The quality indicator >>complete medical treatm ent<< was met for 27.2% of the transported patients. Measured according to present-day criteria, only 18.6% of patients received such optimal treatmen t. Conclusion. This analysis indicates that modern prehospital treatment of st roke patients does not reach adequate standards. In particular, it is not c omprehensive. While the >>action time<< is usually adequate, there are defi ciencies regarding the quality of medical care and the choice of the admiss ion hospital. Further education far emergency physicians with respect to th e management of stroke syndrome should be an integral part of any regional quality programme. The number of hospitals with adequate competence in the acute management of stroke cases is still insufficient.