title: Triage assessments and the activation of rapid care protocols for acute stroke patients.
abstract: BACKGROUND
  Rapid care protocols developed to reduce in-hospital delay times in the assessment of acute stroke patients are now common in Emergency Departments. Correct triage identification and prioritisation is vital to instigate this process and increase the eligibility of patients for acute stroke treatments.
  
  
  OBJECTIVE
  We set out to examine triage assessments of acute stroke patients and investigate factors associated with the instigation of rapid care protocols (allocation of triage category 1 or 2) for acute stroke patients presenting within 2 h of symptom onset.
  
  
  METHODS
  A retrospective assessment of emergency department records was undertaken for stroke patients presenting to three hospitals in Melbourne over six months in 2010.
  
  
  RESULTS
  798 patients were included in the study. Among acute stroke patients who presented within 2 h (n=185), 173 (94%) were identified as stroke at triage with 10 cases identified as "altered conscious state". In all cases not identified as stroke the patient was diagnosed with intracerebral haemorrhage. 132 cases (71%) were allocated a triage category 1 or 2. Facial weakness (p=0.002) and presentation to Monash Medical Centre (p=<0.001), were significantly associated with triage category 1 or 2.
  
  
  CONCLUSIONS
  Virtually all acute stroke patients were identified at triage, however 30% were not allocated an urgent triage category (1 or 2). Further education strategies may be required to develop awareness of rapid care protocols for acute stroke patients among triage nurses and ensure the uniform application of Acute Stroke Guidelines and local rapid care pathways.
authors.affiliation: Monash University, Faculty of Medicine Nursing and Health Sciences, School of Nursing and Midwifery, Melbourne, Australia. ian.mosley@monash.edu
authors.forename: Ian
authors.initials: I
authors.lastname: Mosley
authors.forename: Julia
authors.initials: J
authors.lastname: Morphet
authors.forename: Kelli
authors.initials: K
authors.lastname: Innes
authors.forename: George
authors.initials: G
authors.lastname: Braitberg
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D004636:Emergency Service, Hospital / Q000458:organization & administration; D004638:Emergency Treatment / Q000451:nursing; D005260:Female; D006801:Humans; D008297:Male; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000451:nursing*; D014218:Triage / Q000458:organization & administration*; D014739:Victoria