News | July 09, 2007

Hospital Operators May Fail to Steer People with Stroke Symptoms to Call 9-1-1

July 10, 2007 — Nearly a quarter of hospital or “healthline” operators mistakenly routed a caller describing classic stroke symptoms to primary care doctors rather than 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 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 — call 9-1-1 — nearly a quarter said they would tell the person to call their primary care doctor.

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

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