Addressing Stroke Patient and Family Reasons for Not Calling 911

Objective: Our Comprehensive Stroke Center regularly provides community outreach and stroke education. The stroke team educates on signs and symptoms of stroke, risks factors, and 911 activation. Emergency response units then activate our stroke response teams for prompt treatment in keeping with our motto “time is brain.” Approximately 1/3 of our stroke alerts are walk-ins, and at our sister hospitals (primary and acute stroke ready), nearly 2/3 of their stroke alerts are walk-ins. The purpose of this survey is to determine common reasons why 911 was not called for possible strokes to improve community stroke education interventions. Method: Neuroscience nurses call all stroke patients within a few days of discharge to ensure patients have obtained their prescription medications, have follow-up appointments, inquire about their satisfaction with our services, and reinforce stroke education. In June 2018, as part of these calls, our team asked why patients/families did not call 911, then provided education on the importance of calling EMS. Between 6/6/2018 and 1/7/2019, 588 stroke patients were called and we reached 462 (79%). Of those, 454 cases had transportation information and 97 (22%) patients arrived as a walk-in. Results: Fourteen patients were unsure or could not provide a response as to why 911 was not called. Out of the 83 cases for which an answer was given, 20 patients (24%) reported hospital preference, and did not call because they were sure that EMS would take them to a different, closer hospital. Other responses were that the patient or family did not realize it was an emergency (20%), patient or family member preferred to drive (10%), the patient or family thought it would be faster to drive (16%), the incident occurred close to the hospital or in a car (10%), the cost was prohibitive (5%), or other (16%). Conclusion: The most common reason patients and families gave for not calling 911 was their hospital preference. Fire Officers Association of Miami-Dade (FOAMD) uses an algorithm based on a pre-hospital stroke scale, time since last known well, and distance from scene to stroke center to triage patients. Targeted community educational efforts on this algorithm may lead to higher rates of 911 use for suspected stroke