Emergency medical services (EMS) are the first point of contact for most acute stroke patients. EMS call to hospital times have increased in recent years for stroke patients in the UK which is undesirable due to the relationship between time and effectiveness of reperfusion treatment. This review aimed to identify and describe interventions devised to improve the efficiency of acute stroke care which reported an impact on ground-based EMS call to hospital times. A systematic review of published literature identified from five databases (Medline, EMBASE, CINAHL, the Cochrane library and the Database of Research in Stroke (DORIS)) from January 2000 to December 2020 with narrative synthesis was conducted. Inclusion criteria were primary studies of ground-based EMS, focused on stroke and aiming to improve EMS times. Papers published before 2000, focussing on mobile stroke units or in languages other than English were excluded. Two reviewers independently screened prospective titles. Cochrane ROB2 and ROBINS-I tools were used to assess for risk of bias. This review was funded by a Stroke Association fellowship. From 3767 initial records, 11 studies were included in the review. Included studies were categorised into three groups: studies targeting EMS dispatch and EMS clinicians (n = 4); studies targeting EMS clinicians only (n = 4); and studies targeting whole system change (n = 3). Suspected stroke patients were the primary population studied and most (n = 10) interventions involved clinician education. Only one study (9%) reported a significant decrease in call to hospital time in one subgroup whereas two studies (18%) reported a significant increase in call to hospital time and all other studies (73%) reported no significant change. Based on the included studies, interventions intended to improve the efficiency of the acute stroke pathway rarely improved EMS call to hospital times. Included studies were heterogenous and rarely focussed on the review topic which limits the usability of the findings. Further research is needed to explore the trade-off between changes to EMS stroke care and call to hospital times and subsequent impacts on in-hospital care and patient outcomes.

中文翻译：

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提高急性卒中护理效率的干预措施如何影响院前时间？系统回顾和叙述综合

紧急医疗服务 (EMS) 是大多数急性卒中患者的第一联系点。近年来，英国中风患者的 EMS 呼叫住院时间有所增加，由于时间和再灌注治疗的有效性之间的关系，这是不可取的。本综述旨在确定和描述旨在提高急性卒中护理效率的干预措施，这些干预措施报告了对基于地面的 EMS 呼叫住院时间的影响。对 2000 年 1 月至 2020 年 12 月从五个数据库（Medline、EMBASE、CINAHL、Cochrane 图书馆和中风研究数据库 (DORIS)）中确定的已发表文献进行了系统评价，并进行了叙述性综合。纳入标准是基于地面 EMS 的主要研究，重点关注中风并旨在改善 EMS 时间。2000年以前发表的论文，专注于移动卒中单元或英语以外的语言被排除在外。两名审稿人独立筛选了预期的标题。Cochrane ROB2 和 ROBINS-I 工具用于评估偏倚风险。该审查由中风协会奖学金资助。从 3767 份初始记录中，11 项研究被纳入审查。纳入的研究分为三组：针对 EMS 派遣和 EMS 临床医生的研究（n = 4）；仅针对 EMS 临床医生的研究（n = 4）；以及针对整个系统变化的研究（n = 3）。疑似卒中患者是研究的主要人群，大多数（n = 10）干预措施涉及临床医生教育。只有一项研究 (9%) 报告在一个亚组中就诊时间显着减少，而两项研究 (18%) 报告就诊时间显着增加，而所有其他研究 (73%) 报告没有显着变化。根据纳入的研究，旨在提高急性卒中通路效率的干预措施很少能改善 EMS 就医时间。纳入的研究是异质的，很少关注审查主题，这限制了研究结果的可用性。需要进一步的研究来探索 EMS 中风护理的变化与住院时间的变化以及随后对住院护理和患者结果的影响之间的权衡。旨在提高急性卒中通路效率的干预措施很少能改善 EMS 呼叫住院时间。纳入的研究是异质的，很少关注审查主题，这限制了研究结果的可用性。需要进一步的研究来探索 EMS 中风护理的变化与住院时间的变化以及随后对住院护理和患者结果的影响之间的权衡。旨在提高急性卒中通路效率的干预措施很少能改善 EMS 呼叫住院时间。纳入的研究是异质的，很少关注审查主题，这限制了研究结果的可用性。需要进一步的研究来探索 EMS 中风护理的变化与住院时间的变化以及随后对住院护理和患者结果的影响之间的权衡。