Nearly all people in the United States can access life-saving stroke treatment within an hour by ambulance, no matter where they live in the country, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2022.
Ten years ago, national data suggested that about 1 in 5 people in the United States (20%) could not access the level of timely stroke treatment that could save their lives or prevent future disability. Since then, the addition of more hospitals with the specialized staff, tools, and resources to provide advanced stroke care and the increased use of telecom stroke services (a remote stroke neurologist evaluates and provides recommendations to stroke patients in an emergency room via interactive video conferencing) has expanded. in hospitals across the country, and connects small and rural hospitals with stroke neurologists at specialist stroke centers that are ready to provide remote treatment of stroke around the clock.
“Investments in improving stroke treatment systems have been successful, and we’re seeing improved access to stroke expertise and improved health care for patients who are far from centers of expertise, so that’s a message of hope,” said Kori S. Zachrison, MD. , M.Sc., lead author of the study and associate professor of emergency medicine at Massachusetts General Hospital and Harvard Medical School, both in Boston. “There is a narrow time frame for delivering disability-reducing stroke treatments. Improving post-stroke outcomes for patients depends on a patient’s ability to access that treatment. American population, which is remarkable given the geographical scope of our country. “
The purpose of the new research was to provide an up-to-date overview of stroke centers and emergency departments equipped with telecommunications units and to determine the proportion of the U.S. population with access to these facilities. Researchers gained access to data from the 2020 U.S. Census Bureau combined with the 2019 National Emergency Department Inventory, a collection of all emergency departments across the country. Data from these sources included location, impact center status, and availability of telecommunications services. Using 2019 National Emergency Medical System Information data, they calculated driving times from each census block in the country to the nearest emergency room with telecommuting capacity or the nearest acute stroke ready or primary or comprehensive stroke center (a hospital equipped to deliver time-sensitive acute stroke).
The analysis found:
- Of the 5,587 emergency departments nationwide, 46% in an acute stroke are prepared for hospital or stroke. Of these, 55% also have telecommunications services.
- Of the 3,024 (54%) emergency rooms that are not in an acute stroke ready hospital or stroke, 36% have telecom stroke.
- Researchers estimate that 91% of the U.S. population can reach an emergency stroke clear hospital or stroke center within an hour by ambulance, receive life-saving care, and if tele-stroke-compatible emergency departments are included, that number rises to 96%.
- The percentage of the population without access to a stroke center or telecommutable emergency department varied by region, from 1% in the Mid-Atlantic to 9% in the West Mountain parts of the country (Arizona, Colorado, Idaho, New Mexico, Montana, Utah, Nevada and Wyoming).
“Unfortunately, geography plays a role in access to health care – if you live in rural areas, your access to advanced stroke is not as accessible as if you live in the middle of Boston or New York City, for example. Through telecommuting, we have been able to to start closing geographical differences and improving access to optimal care by bringing stroke expertise to patients where they are – this is profound, “Zachrison said.
In May 2020, stroke experts from the American Heart Association’s Stroke Council issued a new guideline, “Pre-hospital Triage of Acute Stroke Patients Under the COVID-19 Pandemic,” to establish protocols that optimize the management of suspected strokes before arriving at a hospital during the ongoing COVID-19 crisis and future pandemics. One of the goals included enhanced interactive video conferencing (telestroke) networks to assess and provide processing as quickly as possible. An American Stroke Association Policy Statement, Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update, also recognized the value and cost-effectiveness of telecommuting by providing more equitable access to advanced stroke management.
Temporary guidance issued on stroke during COVID-19 pandemic
Provided by the American Heart Association
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