The main problems and defects of the medical care on prehospital stage for patients with acute cerebrovascular accident in Stavropol

Abstract

   The purpose of the study was to identify the care provision defects on prehospital stage in patients with stroke in order to improve the quality of care for this category of patients.   Objectives of the research: to study the frequency of hospitalization the patients with suspected stroke, depending on gender and age; to evaluate the efficiency of the ambulance team’s departure to the patient and the timing of the patient’s delivery to the hospital; to assess the quality of diagnosis and drug therapy at the prehospital stage.   Materials and methods. The analysis of statistical observation forms No. 30, form № 109/y, accounting form № 110/y Stavropol Regional Clinical Emergency Medical Station, as well as case histories of patients with stroke in City Clinical Hospital No. 3, Stavropol, from 2016 to 2020.   Results. A retrospective analysis of accounting and statistical documents of the Ambulance in a five-year period showed a fairly high efficiency in the work of dispatchers – 74.3 % of correct interviewing of patients to identify risk categories; ambulance crew within the framework of efficiency indicators – the time to reach the specialized department in Stavropol was 44 ± 4.1 minutes. However, the analysis of case histories of the ICU revealed violations in the observance of the algorithm for providing medical care to patients with stroke, in the form of: lack of protection of the upper respiratory tract and maintenance of adequate oxygenation — 43 cases (93.4 %); poorly correctable OSHF at the prehospital stage — 12 cases (14.5 %); non-compliance with the algorithm for examining a patient with stroke at the prehospital stage – 11 (13.2 %); lack of provision of adequate venous access – 9 (10.8 %) cases.   Conclusion. The revealed defects of the prehospital stage contributed to the worsening of acute cerebral insufficiency, changes in the volume of the lesion, increased dislocation of brain structures, and in some cases led to daily mortality.