Evidence-based Practice and Emergency Medical Systems (EMS) Among Stroke Patients

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Evidence based Practice and Emergency Medical Systems (EMS)
15.03.2021
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Evidence-based practice is a modern approach in the healthcare sector. According to it, studies should be appraised in order to evaluate the level of evidence, the feasibility of adopting recommended changes, as well as to determine the effect of the change on unit operations, nurse and patient satisfaction, and the changes in the clinical outcomes for estimation of their applicability. Five studies concerning stoke awareness campaigns were considered in the current study with their relation to the evidence-based approach. The studies present evidence for the adoption of appropriate campaign and awareness programs that would effectively reduce pre-hospital delays and increase the activation of Emergency Medical Systems (EMS) among stroke patients and thus, reduce health care costs for patients and improve their quality of life.

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Overall Strength of the Evidence

The five studies on the impact of mass media and public awareness on the activation of EMS and reduction in intervention times for stroke patients were of level II and of quasi-experimental design. In all of them, the researchers presented scientific evidence of high quality, with the application of sufficient sample, and suggested recommendations based on the obtained evidence.

Evidence Information on the Health Problem Issue and Feasibility

Evidence presented by Skolarus et al., (2016) informs on the importance of raising awareness in communities regarding stroke, appropriate identification of this problem, and response rates. According to the results, engaging communities in stroke preparedness is feasible, since it could be managed financially and is likely to achieve the intended results. Flynn et al., (2014), on the other hand, found that the FAST campaigns can be used to improve the information-seeking behavior of the public regarding stroke, as well as contribute to finding appropriate emergency services, where thrombolysis is used. However, the study reports that the impact of the program is moderate in its effectiveness (Flynn et al., 2014). Mass media interventions are feasible in terms of reaching a larger audience but are rather very costly.

Mellon et al. (2013) studied an Irish population, which revealed an increase in seeking emergency services in stroke-related cases after the FAST public campaign in the country. However, the impacts were not sustained for long. It was found that in Australia, the exposure to campaigns led to an increase in the number of stroke-related emergency calls and the use of ambulances for such cases (Bray et al., 2015). Caminiti et al. (2017) are also in agreement with the other scientists that pre-hospital delay in stroke incidences can be greatly reduced by educational campaigns. However, the campaigns were costly given that they covered a significant proportion of the population. At the same time, the researchers also proposed the necessary outcomes, which could be expected, when the right campaigns were more positive in their narrative and urged the people to use EMS. Generally, the impacts of mass media interventions and campaigns were feasible but more effective in areas with no prior exposure to stroke awareness. Mellon et al. (2013) and Skolarus et al. (2016) thus propose community-based educational interventions as more effective in clinical outcomes and less costly means.

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Change and Clinical Outcomes

Prior education on stroke in high-risk communities would improve clinical outcomes by increasing intervention times and activation of EMS. Community education leads to more accurate recognition and more rapid responses to stroke (Skolarus et al., 2016), which are argued to reduce pre-hospital delays that limit the use of acute stroke treatments for stroke patients. The research by Caminiti et al. (2017) also proposes that the adoption of well-tailored educational campaigns are important interventions for the reduction of pre-hospital delays in patients with acute stroke. Skolarus et al. (2016) further claim that increasing the intent to seek help and to activate EMS in patients with acute stroke among the high-risk communities would probably translate into practice if such scenario takes place.

Flynn et al. (2014) found that the FAST campaigns associated with increased awareness about stroke, increased emergency admissions, and contributed to the elevated use of thrombolysis (2014). According to Bray et al., (2015), stroke awareness campaigns led to increased use of ambulatory services within the Australian population. This quick access to medication improves clinical outcomes. Mellon et al. (2013) reported that media campaign was very effective in increasing EMS activation and in self-referral cases to the emergency department. Therefore, adopting appropriate media and community-engaging awareness campaigns are important in achieving quicker intervention times and activation of EMS among stroke patients, which may help in their recovery and result in improvement in the quality of life.

Change and Patient and Nurse Satisfaction

Through the adoption of the publicity campaigns, such as Stroke Ready and FAST interventions, both patients and nurses would be satisfied. Patients will be able to access treatment facilities on time for the administration of acute stroke treatment (Skolarus et al., 2016; Flynn et al., 2014). This means that their quality of life will greatly improve and possible complications and negative outcomes associated with a pre-hospital delay, such as death and disability, will be minimized. Moreover, the encouragement of patients using positive messages in stroke awareness campaigns, as proposed by Caminiti et al. (2017), leads to the encouragement for the patients with stroke and their families. Initial campaign effects, such as those experienced by the Irish FAST awareness program, motivate the patients to utilize the health services available to them, to improve their awareness of the problem (Mellon et al., 2013). Another example of increased use of services for health purposes is the Australian system, in which residents increasingly used ambulatory services for health emergencies (Bray et al., 2015). Through the education of the public, and especially communities at high risk for stroke occurrences, patients are more satisfied, since the quick intervention may enable them to live longer and to avert other side effects of stroke-related to the pre-hospital delay.

The nurses will be more satisfied since proper recognition of stroke makes it much easier to provide patients with high-quality, which reduces stress that comes along with misdiagnosis. Moreover, the well-being of the patients will be greatly improved, which will seriously reduce the workload of the nurses. By activating EMS, the patients give nurses an easier time since these healthcare professionals can attend to the patients before the time window of acute stroke treatment elapses.

Change and the Cost of Care for Patients

Through engaging the communities, rapid responses in accessing help and appropriate recognition of stroke will greatly reduce costs of care for patients. For the patients, using paid ambulatory services, exploring these emergency services would be more expensive (Bray et al., 2015). However, the benefits of the early intervention and treatment of acute stroke greatly justify the cost. Not only do campaigns make the important information concerning stroke readily available to the population, but some of them also teach the public about the symptoms of stroke and how to respond to them appropriately. Therefore, paying for the proper services in case of a correctly diagnosed condition, families and patients will experiment with the cut down of costs for medical care. Also, quick intervention allows for proper treatment, such as thrombolysis, which greatly improves the quality of life of the affected patients. Earlier, interventions reduced any extra costs caused by negative side effects, such as disability and even death, which occur in cases of delayed treatment.

Moreover, the early treatment ensures that hospital and healthcare facilities are utilized more efficiently and thus, costs for care become lower for patients. For instance, accessing patients within the window period for acute treatment would most likely lead to earlier discharge from the hospital and thus, hospital resources would be open for the care about other patients. Therefore, educating the communities on stroke and the importance of early intervention is helpful in reducing healthcare costs for stroke patients.

Change and Unit Operations

Unit operations would be greatly improved by adopting community-based education and stroke awareness programs. For instance, the community and patients would readily be involved in seeking healthcare for the affected persons. Mellon et al. (2013) advocate engaging the community in stroke campaigns as more effective since among other factors, the fear of activating EMS will be alleviated and the obstructions for seeking early intervention in stroke cases will be removed. Therefore, healthcare departments will be able to connect more readily with the communities.

Moreover, healthcare workers will be more aware of the treated disease and thus, would be able to organize their working process more effectively. After the introduction of proper awareness programs, the community would know, whom to contact in cases of any emergency. For example, community and public awareness campaigns would lead to an increase in self-reported individuals in the emergency department after the FAST campaign (Mellon et al., 2013), the activation of EMS (Flynn et al., 2014; Skolarus et al., 2016), the increased use of ambulatory services (Bray et al., 2015), and the resort to contact a primary physician when stroke cases were recognized (Flynn et al., 2014). Primarily, the awareness about stroke symptoms at their onset would facilitate smooth interaction between the community, the ambulatory and EMS departments, and the relevant physician or registered nurse, who are licensed to handle stroke cases.

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Conclusion

Evidence provided by the researchers suggests that campaigns on stroke awareness and interventions are feasible since they activate EMS and reduce pre-hospital delays. However, the content of the message should not be threatening, and should rather be encouraging and instructional. In addition, the campaigns are more effective and less costly at community levels than at the national ones. Therefore, community engagement in stroke awareness campaigns should be implemented to increase the chances for earlier intervention and thus, effective treatment.

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