Family physician decisions following stroke symptom onset and delay times to ambulance call

Background: For stroke patients, calling an ambulance has been shown to be associated with faster times to hospital than contacting a family physician. However little is known about the impact of decisions made by family physicians on delay times for stroke patients once they have been called. We aimed to test the hypotheses that among ambulance transported stroke patients: Factors associated with first calling a family physician, could be identified. Time to ambulance call will be longer when a family physician is first contacted. Medical examination prior to the ambulance call will be associated with longer delay times. Methods: For 6 months in 2004, all ambulance-transported stroke patients who presented from a defined region in Melbourne, Australia to one of three hospitals were assessed. Ambulance and hospital records were analysed. The patient and the person who called the ambulance were interviewed to obtain their description of the stroke event. Results: 198 patients were included in the study. In 32% of cases an ambulance was first called. No demographic or situational factors were associated with first calling a doctor. Patients with a history of stroke or TIA were less likely to call a doctor following symptom onset (p = 0.01). Patients with a severe stroke (Glasgow Coma Scale < 9) never called a doctor first. When a family physician was contacted (22% of cases), the time to ambulance call was significantly longer than when an ambulance was first called (p = 0.0018) (median 143 and 44 minutes, respectively). In 36% of calls to a family physician, the doctor elected to first examine the patient. Time to ambulance call was shorter when the doctor vetted the call and advised the caller to immediately call an ambulance (45%) (median 412 and 92 minutes respectively: p = 0.06). Conclusion: Time delays to ambulance call were significantly longer for stroke patients when a family physician was first contacted. Further extensive delays were experienced by patients when the family physician elected to examine the patient. Family physicians and their staff have an important role to play in averting potential delays for stroke patients by screening calls and providing immediate advice to "call an ambulance".