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Adherence to ambulance performance indicators and patient outcomes after stroke: An Australian data linkage study.

Amminadab L Eliakundu, Joosup Kim, Karen Smith, Monique F Kilkenny, Mulugeta M Birhanu, Kathleen L Bagot, Emily Nehme, Shelley Cox, Bruce C V Campbell, Ben Clissold and 5 more

Australasian Emergency Care · 2025-07-04 · Observational study

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Abstract

BACKGROUND: The impact of Emergency Medical Service (EMS) stroke performance indicators on patient outcomes is unclear. We aimed to evaluate adherence to EMS indicators (15 minutes response, 60 minutes transport to a stroke centre or both) and associations with treatment access and patient outcomes. METHOD: Retrospective cohort study using data from the Australian Stroke Clinical Registry and ambulance records from Victoria (2015-2017) for patients (≥18 years) with stroke transported by ambulance. Multivariable regression models were used to evaluate EMS adherence to performance indicators and outcomes of interest. RESULTS: Among 4206 patients (72 years; 42 % female), EMS indicators were less frequently met for patients in regional areas (aOR: 0.27; 95 % CI: 0.17, 0.43). Socio-economic disparities were observed, with patients in advantaged areas less likely to receive an ambulance response within 15 minutes. Adherence to EMS performance indicators was associated with shorter off-stretcher time and increased thrombolytic therapy use (aOR: 1.62; 95 % CI: 1.24, 2.11). EMS adherence to performance indicators did not significantly impact functional independence, or health-related quality of life. CONCLUSIONS: EMS adherence to performance indicators improved off-stretcher time and thrombolytic therapy use but was influenced by geographic and socio-economic status. Refining EMS performance targets and tailoring public and EMS education on stroke is needed.

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Tags

Antithrombotics & thrombolytics · Equity & disparities · Offload delay & turnaround · Rural & remote · Thrombolytics · Time intervals

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