Background: Treatment for stroke is time critical and time limited. Missed identification of stroke in patients presenting to Emergency Departments (ED) results in treatment delays, and sometimes irreversible damage.
Aims: We aimed to increase the number of stroke patients triaged as Australasian Triage Scale (ATS) Category 1 (to be seen immediately) or 2 (to be seen within 10 minutes) following implementation of the BEFAST triage stroke identification process; and to decrease door-to-CT time.
Methods: Implementation of BEFAST involved short education sessions at handover, targeted education with individual staff members across the ED nursing and medical workforce over X weeks, and posters placed around the department. Our pre-test/ post-test study used prospective patient data from BEFAST calls (n=331). Retrospective patient record audits for confirmed stroke (n=254) were undertaken. Information on triage category, ED presentation and time to CT scan, discharge destination, length of stay (LOS), and modified Rankin Score (mRS) were extracted and analysed.
Results: Following the introduction of BEFAST, patients were three times more likely to be triaged at category 1 or 2 (57.4% vs 80.2%, p < 0.001). Door-to-CT scan time was reduced by an average of 20.7 minutes (p < 0.001), with half seen in 48 minutes or less. More patients were discharged to their usual residence (± supports), and more quickly (LOS 7.9 vs 11.1 days, p = 0.001). 90-day post-implementation, patients were nearly twice as likely to experience an improvement in neurological symptoms during this (mRS <=1: 52.2% vs 36.3%, p < 0.001).
Conclusion: Patient outcomes were improved following implementation of the BEFAST stroke triage process. More stroke patients were identified upon presentation to the ED, and in a timely fashion. For those with a stroke diagnosis, time-critical interventions can take place earlier, allowing patients to return home sooner, and with less disability.