Background: Patients with a presumed diagnosis of acute coronary syndrome (ACS) or stroke may have had\ncontact with several healthcare providers prior to hospital arrival. The aim of this study was to describe the various\nprehospital paths and the effect on time delays of patients with ACS or stroke.\nMethods: This prospective observational study included patients with presumed ACS or stroke who may choose\nto contact four different types of health care providers. Questionnaires were completed by patients, general\npractitioners (GP), GP cooperatives, ambulance services and emergency departments (ED). Additional data were\nretrieved from hospital registries.\nResults: Two hundred two ACS patients arrived at the hospital by 15 different paths and 243 stroke patients by\nten different paths. Often several healthcare providers were involved (60.8 % ACS, 95.1 % stroke). Almost half of all\npatients first contacted their GP (47.5 % ACS, 49.4 % stroke). Some prehospital paths were more frequently used,\ne.g. GP (cooperative) and ambulance in ACS, and GP or ambulance and ED in stroke. In 65 % of all events an\nambulance was involved. Median time between start of symptoms and hospital arrival for ACS patients was over\n6 h and for stroke patients 4 h. Of ACS patients 47.7 % waited more than 4 h before seeking medical advice\ncompared to 31.6 % of stroke patients. Median time between seeking medical advice to arrival at hospital was\nshortest in paths involving the ambulance only (60 min ACS, 54 min stroke) or in combination with another\nhealthcare provider (80 to 100 min ACS, 99 to 106 min stroke).\nConclusions: Prehospital paths through which patients arrived in hospital are numerous and often complex,\nand various time delays occurred. Delays depend on the entry point of the health care system, and dialing the\nemergency number seems to be the best choice. Since reducing patient delay is difficult and noticeable differences\nexist between various prehospital paths, further research into reasons for these different entry choices may yield\npossibilities to optimize paths and reduce overall time delay.
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