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ESCORTT: Emergency Stroke Calls: Obtaining Rapid Telephone Triage

The overall aim of ESCORTT was to facilitate recognition of stroke by EMDs who are key in facilitating the public’s access to the emergency services by:

Phase 1: Identifying a cohort of patients in hospital with a final diagnosis of stroke and exploring the identification and diagnosis of stroke in this cohort by ambulance dispatchers and ED staff;

Phase 2: Exploring communication between the public and ambulance dispatchers to explore the features that expedited or delayed people’s initial decision to contact EMS;

Phase 3: Exploring communication of the patients in Phase 1 with ambulance dispatchers to identify the ‘key indicator’ words for suspected stroke; and to compare these with the final diagnosis in hospital;

Phase 3a: Identifying how patients’ conscious level was questioned, described and interpreted by callers and EMDs;

Phase 4: Comparing the words used by the public making 999 calls to the EMS, the subsequent ambulance dispatch codes and final diagnosis in hospital, for stroke and non-stroke calls;

Phase 5: Developing algorithms and protocols for ambulance and NHS Direct staff to assist in the identification of those with suspected stroke.

Phase 6: Developing an on-line training package for Emergency Medical Dispatchers informed by the previous phases;

Phase 7: Implementing the training package and evaluating the content within one EMD control centre;

Phase 8: Evaluating the impact of this newly developed stroke-specific, training package on the recognition of stroke by Emergency Medical Dispatchers.

Impact

The content of the stroke specific training package was based on earlier phases of ESCORTT and has been widely published (Jones et al., 2011; Gibson et al. 2012; Jones et al. 2012).

The percentages of those with final diagnosis of stroke who were correctly dispatched by EMS were 63.0% in the pre-implementation phase, rising to 87.5% during implementation, and remaining higher than baseline at 79.7% post-implementation.

The training package also improved aspects of pre-hospital delay, amounting to a mean overall reduction of more than 10 minutes from time of call to emergency department diagnosis.

It has been estimated that a typical patient loses 1.9 million neurons each minute in which stroke is untreated (Saver, 2006) and the benefits of rapid diagnosis of stroke on improving both mortality and morbidity are well-recognised.

The ESCORTT training package has been endorsed by the UK Forum Stroke Education and Training. Available to all health professionals via UK Forum Stroke Education and Training.

Timeline

2007-2013

Funders

National Institute for Health Research Stroke Programme Grant

Public Outputs

Leathley MJ, Jones SP, Gibson JEM, Ford GA, McAdam JJ, Quinn T, Watkins CL, on behalf of the Emergency Stroke Calls: Obtaining Rapid Telephone Triage Group. “Can you send an ambulance please?”: A comparison of callers’ requests for emergency medical dispatch in stroke and non-stroke calls. Emergency Medicine Journal. (on-line publication 13 July 2013). (in press). doi:10.1136/emermed-2013-202752

Jones SP, Carter B, Ford GA, Gibson JME, Leathley MJ, McAdam JJ, O'Donnell M, Punekar S, Quinn T, Watkins CL, on behalf of the ESCORTT group. The identification of acute stroke: an analysis of emergency calls. International Journal of Stroke. 2013;8(6):408-412. doi: 10.1111/j.1747-4949.2011.00749.x

Watkins CL, Leathley MJ, Jones SP, Ford GA, Quinn T, Sutton CJ. Training emergency services' dispatchers to recognise stroke: an interrupted time-series analysis. BMC Health Services Research. 2013;13(1):318. doi:10.1186/1472-6963-13-318

Gibson JME, Bullock M, Ford GA, Jones SP, Leathley MJ, McAdam JJ, Quinn T, Watkins CL, on behalf of the ESCORTT group. “Is he awake?”: Dialogues between callers and call handlers about consciousness during emergency calls for suspected acute stroke. Emergency Medicine Journal. 2013;30(5):414-418. doi: 10.1136/emermed-2012-201195

Jones SP, Dickinson HA, Ford GA, Gibson JME, Leathley MJ, McAdam JJ, McLoughlin A, Quinn T, Watkins C, on behalf of the ESCORTT group. Callers' experiences of making emergency calls at the onset of acute stroke: a qualitative study. Emergency Medicine Journal. 2012;29(6):502-505. doi: 10.1136/emj.2010.108563

Abstracts (including abstracts presented as posters or oral presentations)

Jones SP, Ford GA, Leathley MJ, McAdam JJ, McLoughlin AS, Quinn T, Watkins CL, on behalf of the ESCORTT Group. An evaluation of stroke-specific training for Emergency Medical Dispatchers. Cerebrovascular Diseases. 2012;33(Suppl 2):616-617. [Presented as poster at XXI European Stroke Conference, 22-25 May 2012, Lisbon, Portugal].

Jones SP, Sharma A, Dodd A, Leathley MJ, McAdam JJ, Quinn T, Sutton CJ, Watkins CL, on behalf of the ESCORTT Group. Training call handlers to recognise stroke: The evaluation and impact of a training package. International Journal of Stroke. 2011;6(Suppl 2):5. [Oral presentation by Jones SP at 6th UK Stroke Forum Conference, 30 November 2011, Glasgow, UK].

Jones SP, McAdam JJ, McLoughlin ASR, Gibson JM, Leathley MJ, Watkins CL, on behalf of Emergency Stroke Calls: Obtaining Rapid Telephone Triage Group. Understanding of the term conscious when used during emergency calls for suspected stroke. Cerebrovascular Diseases. 2011;31(Suppl 2):234. [Presented as poster by Jones SP at XX European Stroke Conference, 24-27 May 2011, Hamburg, Germany].

Sutton CJ, Dickinson H, Jones SP, Leathley MJ, McLoughlin A, Watkins CL, on behalf of the Emergency Stroke Calls: Obtaining Rapid Telephone Triage Group. Emergency stroke calls obtaining rapid telephone triage (ESCORTT) phase 1: how and when are patients diagnosed with stroke? International Journal of Stroke. 2010;5(Suppl 3):15. [Presented as poster at 5th UK Stroke Forum Conference, 30 November-2 December 2010, Glasgow, UK].

Jones SP, McAdam JJ, Gibson JME, Leathley MJ, Dodd A, Watkins CL, on behalf of the Emergency Stroke Calls: Obtaining Rapid Telephone Triage Group. How do callers describe symptoms when contacting emergency services at the onset of acute stroke? A study of the “first story” given by callers. International Journal of Stroke. 2010;5(Suppl 3):14. [Presented as poster at 5th UK Stroke Forum Conference, 30 November-2 December 2010, Glasgow, UK].

Jones SP, Gibson JME, Leathley MJ, McAdam JJ, Watkins CL. Public’s response to acute stroke symptoms in the UK: a qualitative study. Cerebrovascular Diseases. 2010;29(Suppl 2):332. [Presented as poster at XIX European Stroke Conference, 25-28 May 2010, Barcelona, Spain].

Jones S, Dickinson H, Gibson JME, Leathley M, McAdam J, McDonald K, McLoughlin A, Watkins C, on behalf of the ESCORTT group. Caller experiences of dialling 999 for suspected stroke. International Journal of Stroke. 2009;4(Suppl 2):13. [Presented as poster at 4th UK Stroke Forum Conference, 1-3 December 2009, Glasgow, UK].

Jones S, Leathley M, McDonald K, Watkins C, on behalf of the ESCORTT Group. Pre-hospital identification of stroke. 3rd UK Stroke Forum Conference Book of Abstracts. 2008:22-23. [Presented as poster at 3rd UK Stroke Forum Conference, 2-4 December 2008, Harrogate, UK].

Additionally more than 10 posters and symposia presented at various national and international conferences including the UK Stroke Forum Conference and European Stroke Conference.

Press releases / Magazine articles / On-line publications

Watkins C. Emergency stroke calls: obtaining rapid telephone triage. Stroke Matters. 2009;2:14.

Watkins C, Leathley M, Jones S. Funding awarded for ESCORTT. One million pound Department of Health grant for stroke care research. UCLAN Research Newsletter. 2008;Issue 4:16.

Jones S. Acute stroke training for health professionals. UCLAN Research Newsletter CRIT Supplement. 2008; Number 2:19.

Further Information

For further information about the project, please contact Stephanie Jones

Collaborators and Partners

 

Applicants

Caroline Watkins, Professor of Stroke and Older People’s Care, Clinical Practice Research Unit, University of Central Lancashire.

Gary Ford, Professor of Pharmacology of Old Age, Institute for Ageing and Health, Newcastle General Hospital.

Professor Kevin Mackway-Jones, Medical Director, Research and Development, North West Ambulance Service NHS Trust.

Stuart Durham, Consultant in Emergency Medicine, Accident and Emergency Department, Lancashire Teaching Hospitals NHS Foundation Trust.

Tom Quinn, Professor of Clinical Practice, Faculty of Health and Medical Sciences,
University of Surrey.

Mike Rose, Director of Business Development, Performance Directorate, Lancashire Teaching Hospitals NHS Foundation Trust.

Michael Leathley, Post-Doctoral Research Fellow, Clinical Practice Research Unit, University of Central Lancashire.

Stephanie Jones, Research Fellow, Clinical Practice Research Unit, University of Central Lancashire.

Sara Morris, R&D Manager for User Involvement, Health R&D North West, Lancaster University.

Collaborators

Alison Walker, Medical Director and National Stroke Lead, Yorkshire Ambulance Service NHS Trust.

Enid Povey, National Clinical Development Manager, NHS Direct.

Dr Mark O’Donnell, Consultant Physician, Stroke Unit, Blackpool, Fylde and Wyre NHS Trust.

Project Lead

Stephanie Jones

E-mail. sjones10@uclan.ac.uk

Tel. 01772 895107

Project Staff

Caroline Watkins

Stephanie Jones

Michael Leathley

Chris Sutton

 

Joanna McAdam

Jo Gibson

Alison McLoughlin

Hazel Dickinson

Mike Bullock