Intense Education Shortens Arrival Time To ER For Stroke Patients

Dr. Bernadette Boden-Albala MPH, DrPH Associate Dean of Program Development NYU’s College of Global Public Interview with:
Dr. Bernadette Boden-Albala MPH, DrPH
Associate Dean of Program Development
NYU’s College of Global Public Health

Medical Research: What is the background for this study? What are the main findings?

Response: Stroke is a leading cause of morbidity and mortality globally and in the US.  The US Food and Drug Administration has approved tissue plasminogen activator (tPA) as treatment for acute ischemic strokes within 3 hours of the onset of stroke symptoms.  However, less than 25% of eligible stroke patients arrive to an emergency department (ED) in time to receive treatment with tPA.  Our study, the Stroke Warning Information and Faster Treatment (SWIFT), compares the effect of an interactive intervention (II) with enhanced educational (EE) materials on recurrent stroke arrival times.

The II group included in-hospital interactive group sessions consisting of a community placed preparedness PowerPoint presentation; a stroke survivor preparedness narrative video; and the use of role-playing techniques to describe stroke symptoms. Both groups received standardized educational materials focused on being prepared to recognize and react to stroke symptoms plus a medical alert bracelet so medical professionals would recognize them as SWIFT participants.

We found that at follow-up, 42 percent of these patients arrived to the emergency room within 3 hours compared to only 28 percent at baseline, a 49 percent increase in the proportion of all patients arriving within three hours of symptom onset. Among Hispanics, there was a 63 percent increase.  While there was no difference in the proportion arriving within 3 hours between intervention groups, the intensive intervention appeared to be more beneficial in those with early recurrent events within the first 30 days.

Medical Research: What should clinicians and patients take away from your report?

Response: For clinicians, the continued low rate of arrival to the ED within three hours suggests we may not be effectively disseminating stroke preparedness messages.  Our findings suggest that at a minimum, clear, simple, preparedness-focused messages before hospital discharge – and possibly follow-up reinforcement – would result in a greater proportion of early emergency room arrivals. Moreover, culturally tailored, health literate educational materials may decrease racial disparities in stroke outcomes.  This work is especially important for patients because it suggests that with the right information, patients and family members can take control of their health, recognize stroke symptoms and get to the emergency room more quickly.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: Further research is needed to identify the optimal way to deliver stroke preparedness messages.  While we documented an unprecedented level of early ED arrival in our study, we know that stroke care, specifically recognition of a stroke event, comes from a patients care network.  Thus, involvement of a patient’s care network or family may yield an even greater rate of early ED arrival.


Bernadette Boden-Albala, Joshua Stillman, Eric T. Roberts, Leigh W. Quarles, M. Maria Glymour, Ji Chong, Harmon Moats, Veronica Torrico, and Michael C. Parides. Comparison of Acute Stroke Preparedness Strategies to Decrease Emergency Department Arrival Time in a Multiethnic Cohort: The Stroke Warning Information and Faster Treatment Study. Stroke, June 2015 DOI: 10.1161/STROKEAHA.114.008502

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Dr. Bernadette Boden-Albala MPH, DrPH, Associate Dean of Program Development, & NYU’s College of Global Public Health (2015). Intense Education Shortens Arrival Time To ER For Stroke Patients 

Last Updated on June 26, 2015 by Marie Benz MD FAAD