In patients with suspected strokes that are FAST positive does direct conveyance to CT reduce door to scan time?

Doherty, Michelle (2017) In patients with suspected strokes that are FAST positive does direct conveyance to CT reduce door to scan time? Masters thesis, University of Cumbria. Item availability may be restricted.

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Abstract

Since the formation of state registered paramedics (1999) the ambulance service has evolved into a service that not only transports patients to Accident and Emergency (A&E) but into a mobile health unit. It is capable of assessing patients’ needs on scene and directing them to the most appropriate treatment pathway. Taking this into account the assessing of patients presenting with stroke symptoms will be explored with the view to directly referring these patients to CT for immediate scanning, bypassing other departments. Stroke is a leading cause of death, long-term disability, and socioeconomic costs, highlighting the urgent need for more effective treatments (Jaffer et al, 2011). Currently the only proven treatment for acute ischemic strokes is intravenous thrombolysis, but this is time dependent (Yprezelle et al, 2014) and must be identified by CT imaging. The Stroke Association (2017) state that only 46% of patients receive brain scans within the recommended one hour time-frame, allowing for only 1.8% to be thrombolysed, this is significantly below the 4% national target (Royal College of Physicians, 2015). Reasons for this have been attributed to delayed on scene times by paramedics (Puolakka et al (2016), delays in assessment by specialist stroke physicians, which increases waiting times for scanning, resulting in stroke patients exceeding the 4.5 hour (from symptom onset) window for thrombolysis treatment. To reduce these waiting times this project will explore if transporting FAST positive patients directly to CT would reduce door to scan (DTS) times, resulting in reduced door to needle (DTN) time. This is currently done with patients who are suffering Myocardial Infarctions (MI) who bypass A&E and are taken directly to Primary Percutaneous Coronary Intervention (PPCI) departments on the basis of ECG interpretation of paramedics (JRCALC, 2016). The Royal College of Physicians Sentinel Stroke National Audit Programme (2017) claim that a single stroke can cost the NHS £45,000 over a five year period, and claim that early thrombolysis is key to reducing this cost, with Saka et al (2009) stating a cost saving of £4100 per patient can be made with early thrombolysis. This requires collaborative working from the ambulance service and the receiving hospitals, to reduce these costs. It is the authors belief that by transporting patients directly to CT to facilitate tPA, then a cost saving will ensue.

Item Type: Thesis (Masters)
Departments: Faculty of Health and Science > Nursing, Health and Professional Practice
Additional Information: Dissertation submitted in part fulfilment for the MSc Practice Development: Enhancing Paramedic Practice.
Depositing User: Anna Lupton
Date Deposited: 13 Oct 2017 10:11
Last Modified: 14 Oct 2017 17:16
URI: http://insight.cumbria.ac.uk/id/eprint/3298

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