title: FASTER (Face, Arm, Speech, Time, Emergency Response): experience of Central Coast Stroke Services implementation of a pre-hospital notification system for expedient management of acute stroke.
abstract: Despite benefit in acute ischaemic stroke, less than 3% of patients receive tissue plasminogen activator (tPA) in Australia. The FASTER (Face, Arm, Speech, Time, Emergency Response) protocol was constructed to reduce pre-hospital and Emergency Department (ED) delays and improve access to thrombolysis. This study aimed to determine if introduction of the FASTER protocol increases use of tPA using a prospective pre- and post-intervention cohort design in a metropolitan hospital. A pre-hospital assessment tool was used by ambulance services to screen potential tPA candidates. The acute stroke team was contacted, hospital bypass allowed, triage and CT radiology alerted, and the patient rapidly assessed on arrival to ED. Data were collected prospectively during the first 6 months of the new pathway and compared to a 6-month period 12 months prior to protocol initiation. In the 6 months following protocol introduction, 115 patients presented within 24 hours of onset of an ischaemic stroke: 22 (19%) received thrombolysis, significantly greater than five (7%) of 67 patients over the control period, p=0.03. Overall, 42 patients were referred via the FASTER pathway, with 21 of these receiving tPA (50%). One inpatient stroke was also treated. Only two referrals (<5%) were stroke mimics. Introduction of the FASTER pathway also significantly reduced time to thrombolysis and time to admission to the stroke unit. Therefore, fast-track referral of potential tPA patients involving the ambulance services and streamlined hospital assessment is effective and efficient in improving patient access to thrombolysis.
authors: Department of Neurosciences, Gosford Hospital, Gosford, New South Wales 2250, Australia. billob999@gmail.com
authors: W
authors: W
authors: O'Brien
authors: D
authors: D
authors: Crimmins
authors: W
authors: W
authors: Donaldson
authors: R
authors: R
authors: Risti
authors: T A
authors: TA
authors: Clarke
authors: S
authors: S
authors: Whyte
authors: J
authors: J
authors: Sturm
mesh_terms: D001132:Arm; D019468:Disease Management; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards; D004636:Emergency Service, Hospital / Q000592:standards; D005145:Face; D006801:Humans; D011446:Prospective Studies; D013060:Speech; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy*; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy / Q000379:methods / Q000592:standards; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage
chemical_list: D010959:Tissue Plasminogen Activator