Abstract W P209: Trends in Hospital Certification and EMS Utilization of Primary Stroke Centers

Objective: In December 2003, the Joint Commission began certifying primary stroke centers (PSCs). Preferential routing of suspected stroke cases by Emergency Medical Services (EMS) to PSCs is recommended by the American Heart Association and Philadelphia EMS officially enacted such a policy in October 2011. We assessed trends in hospital bypass over time and estimated the time cost of bypassing the nearest hospital. Methods: Data from the Philadelphia EMS database was used to identify patients with a prehospital impression of stroke, defined by EMS provider impression, between January 2004 and December 2013. PSC status and date of initial certification was determined for each of the 22 hospitals in the region. Travel distances and estimated transport times from the scene to all area hospitals were calculated. Results: The number of PSCs increased over time from 1 hospital in 2004 to 17 in 2013. There were a total of 15,034 cases. The proportion of cases arriving at PSCs increased from 6.3% in 2004 to 87.6% in 2013. There was an increase in the total proportion of cases in which EMS bypassed the closest hospital, 36.9% in 2004 to 41.4% in 2013, p=.006. As more hospitals became PSCs, bypass of the closest hospital to arrive at non-PSCs decreased while bypass of the closest hospital to arrive at PSCs increased (Figure 1). Hospitals that would eventually become certified as PSCs received 79.8% of stroke cases in 2004 and 87.6% in 2013, p<.001. Patients who bypassed the closest hospital for a PSC had longer mean transport times than patients transported to the closest, non-PSC, 9.0 vs. 5.0 minutes, p<0.001. Conclusions: EMS bypass of the closest hospital was common before there was an official destination policy and has only modestly increased over the study period. Increasing numbers of patients were treated at PSCs over time, primarily due to increasing numbers of PSCs. ![][1] [1]: /embed/graphic-1.gif