title: Hospital-directed feedback to Emergency Medical Services improves prehospital performance.
abstract: OBJECTIVE
  A potential way to improve prehospital stroke care and patient handoff is hospital-directed feedback for emergency medical service (EMS) providers. We evaluated whether a hospital-directed EMS stroke follow-up tool improved documentation of adherence to the Rhode Island state prehospital stroke protocol for EMS providers.
  
  
  METHODS
  A standardized, 10-item feedback tool was developed in 2012 and sent to EMS directors for every transported patient with a discharge diagnosis of ischemic stroke. We reviewed patient charts meeting these criteria between January 2008 and December 2013. Performance on the tool was compared between the preintervention (January 2008 through January 2012) and postintervention (February 2012 through December 2013) periods.
  
  
  RESULTS
  We identified 1176 patients with ischemic stroke who arrived by EMS in the study period: 668 in the preintervention period and 508 in the postintervention period. The overall score for the preintervention group was 5.31 and for the postintervention group 6.42 (P<0.001). Each of the 10 items, except checking blood glucose, showed statistically significant improvement in the postintervention period compared with the preintervention period.
  
  
  CONCLUSIONS
  Hospital-directed feedback to EMS was associated with improved overall compliance with state protocols and documentation of 9 out of 10 individual items. Future confirmatory studies in different locales and studies on the impact of this intervention on actual tissue-type plasminogen activator administration rates and EMS personnel knowledge and behavior are needed.
authors.affiliation: From Department of Emergency Medicine (B.C.) and Stroke Center (C.A., J.-A.S., B.S.), Rhode Island Hospital, Providence; Department of Emergency Medicine (B.C.) and Department of Quality Management (C.G.M.), The Miriam Hospital, Providence, RI; and Department of Emergency Medicine (D.T.), Newport Hospital, RI.
authors.forename: Bryan
authors.initials: B
authors.lastname: Choi
authors.affiliation: From Department of Emergency Medicine (B.C.) and Stroke Center (C.A., J.-A.S., B.S.), Rhode Island Hospital, Providence; Department of Emergency Medicine (B.C.) and Department of Quality Management (C.G.M.), The Miriam Hospital, Providence, RI; and Department of Emergency Medicine (D.T.), Newport Hospital, RI.
authors.forename: Devin
authors.initials: D
authors.lastname: Tsai
authors.affiliation: From Department of Emergency Medicine (B.C.) and Stroke Center (C.A., J.-A.S., B.S.), Rhode Island Hospital, Providence; Department of Emergency Medicine (B.C.) and Department of Quality Management (C.G.M.), The Miriam Hospital, Providence, RI; and Department of Emergency Medicine (D.T.), Newport Hospital, RI.
authors.forename: Celia Gomes
authors.initials: CG
authors.lastname: McGillivray
authors.affiliation: From Department of Emergency Medicine (B.C.) and Stroke Center (C.A., J.-A.S., B.S.), Rhode Island Hospital, Providence; Department of Emergency Medicine (B.C.) and Department of Quality Management (C.G.M.), The Miriam Hospital, Providence, RI; and Department of Emergency Medicine (D.T.), Newport Hospital, RI. camedee1@lifespan.org.
authors.forename: Caryn
authors.initials: C
authors.lastname: Amedee
authors.affiliation: From Department of Emergency Medicine (B.C.) and Stroke Center (C.A., J.-A.S., B.S.), Rhode Island Hospital, Providence; Department of Emergency Medicine (B.C.) and Department of Quality Management (C.G.M.), The Miriam Hospital, Providence, RI; and Department of Emergency Medicine (D.T.), Newport Hospital, RI.
authors.forename: Jo-Ann
authors.initials: JA
authors.lastname: Sarafin
authors.affiliation: From Department of Emergency Medicine (B.C.) and Stroke Center (C.A., J.-A.S., B.S.), Rhode Island Hospital, Providence; Department of Emergency Medicine (B.C.) and Department of Quality Management (C.G.M.), The Miriam Hospital, Providence, RI; and Department of Emergency Medicine (D.T.), Newport Hospital, RI.
authors.forename: Brian
authors.initials: B
authors.lastname: Silver
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000628:therapy*; D004632:Emergency Medical Services / Q000592:standards*; D030141:Feedback, Psychological; D005260:Female; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies; D012237:Rhode Island; D020521:Stroke / Q000628:therapy*; D016896:Treatment Outcome
keywords: emergency medical services; feedback; stroke