Title

Door-to-Imaging Time for Acute Stroke Patients Is Adversely Affected by Emergency Department Crowding

UMMS Affiliation

Department of Emergency Medicine; School of Medicine

Date

1-1-2017

Document Type

Article

Disciplines

Cardiovascular Diseases | Emergency Medicine | Nervous System Diseases

Abstract

BACKGROUND AND PURPOSE: National guidelines call for door-to-imaging time (DIT) within 25 minutes for suspected acute stroke patients. Studies examining factors that affect DIT have focused primarily on stroke-specific care processes and patient-specific factors. We hypothesized that emergency department (ED) crowding is associated with longer DIT.

METHODS: We conducted a retrospective investigation of 1 year of consecutive patients in our prospective Code Stroke registry, which included all ED stroke team activations. The registry and electronic health records were abstracted for 27 potential predictors of DIT, including patient, stroke care process, and ED operational factors. We fit a multivariate logistic regression model and calculated odds ratios and 95% confidence intervals. Second, we constructed a random forest recursive partitioning model to cross-validate our findings and explore the proportional importance of each category of predictor. Our primary outcome was the binary variable of DIT within the 25-minute goal.

RESULTS: A total of 463 patients met inclusion criteria. In the regression model, ED occupancy rate emerged as a predictor of DIT, with odds ratio of 0.83 (95% confidence interval, 0.75-0.91) of DIT within 25 minutes per 10% absolute increase in ED occupancy rate. The secondary analysis estimated that ED operational factors accounted for nearly 14% of the algorithm's prediction of DIT.

CONCLUSIONS: ED crowding is associated with reduced odds of meeting DIT goals for acute stroke. In addition to improving stroke-specific processes of care, efforts to reduce ED overcrowding should be considered central to optimizing the timeliness of acute stroke care.

Rights and Permissions

Stroke. 2017 Jan;48(1):49-54. doi: 10.1161/STROKEAHA.116.015131. Epub 2016 Nov 17. Link to article on publisher's site

Comments

Co-author Evangelia Murray is a medical student at UMass Medical School.

Related Resources

Link to Article in PubMed

Keywords

crowding, emergency service, hospital, stroke, time-to-treatment

PubMed ID

27856953