Hospital operators may fail to steer people with stroke symptoms to call 911

July 05, 2007

Nearly a quarter of hospital or "healthline" operators mistakenly routed a caller describing classic stroke symptoms to primary care doctors rather than to 9-1-1, according to a research project published in Stroke: Journal of the American Heart Association.

Brett Jarrell, M.D., lead author of the study and emergency department (ED) staff physician at Cabell Huntington Hospital in Huntington, W.Va., said he noticed the problem when he worked at a stroke center.

"So many of our patients were transferred to our facility more than three hours after their symptom onset - sometimes as late as days after their symptoms started," Jarrell said. "I would ask them why they waited, and many replied that they called their local hospitals, only to be told that they should contact their primary care doctors instead of calling 9-1-1."

Stroke is an emergency and with each passing minute brain tissue dies - increasing the odds of disability or death. Patients with an ischemic (clot-caused) stroke - the most common type - can receive a clot-busting drug that reduces disability but they must receive it within three hours of symptom onset. To study whether this was a significant reason why stroke patients weren't getting timely care, Jarrell and colleagues identified hospitals in the United States that offer neurology residencies. They thought these hospitals would be the best at treating stroke and properly handling patients calling with stroke symptoms.

He called the hospitals' main numbers or the help lines/healthlines that many hospitals offer for medical advice. Jarrell identified himself as a researcher to the 46 help lines that participated. He described this stroke scenario: a 65-year-old man experiencing weakness in the left arm and leg and having trouble speaking. Jarrell asked the operators which of these four responses they would give to such a person: wait for symptom resolution, contact a primary care physician, drive to a local urgent care center or call 9-1-1 for ambulance transport.

While 78 percent gave the correct answer -- to call 9-1-1 -- nearly a quarter of those surveyed said they would tell the person to call their primary care doctor.

"This is of great concern," Jarrell said. "Diverting patients away from emergency responders places them in jeopardy of falling out of the critical time window for therapy."

The survey also found that 24 percent of the operators could not name one stroke symptom.

"There is a general lack of education in the community, especially about the specifics of stroke symptoms and treatment," Jarrell said. "Stroke doesn't always present in the classic sense, but some common symptoms are: sudden trouble speaking, sudden weakness or numbness on one side of the body, sudden loss of vision or unresponsiveness in severe cases."

If you suspect stroke, call 9-1-1 immediately, he said.

Jarrell and colleagues will conduct similar surveys with primary care physicians to determine the percentage of doctors that recognize symptoms and route patients to the ED. They will also research responses from 9-1-1 dispatchers and health maintenance organizations (HMOs). "This study definitely suggests that, as a medical community, we are going to have to tighten the reins on who is giving information to patients with acute conditions and educate everyone on what stroke is," Jarrell said.
Co-authors are Allison Tadros, M.D.; Charles Whiteman, M.D.; Todd Crocco, M.D. and Stephen M. Davis, M.P.A., M.S.W. Editor's note: For more information on stroke, visit the American Stroke Association Web site:

Statements and conclusions of study authors that are published in the American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect association policy or position. The American Heart Association makes no representation or warranty as to their accuracy or reliability.

NR07-1164 (Stroke/Jarrell)

American Heart Association

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