scholarly journals Off-Hours Admission and Acute Stroke Care Quality

Stroke ◽  
2014 ◽  
Vol 45 (12) ◽  
pp. 3663-3669 ◽  
Author(s):  
Nina Sahlertz Kristiansen ◽  
Jan Mainz ◽  
Bente Mertz Nørgård ◽  
Paul D. Bartels ◽  
Grethe Andersen ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Care Quality ◽  
Acute Stroke Care

scholarly journals Bottlenecks in the Acute Stroke Care System during the COVID-19 Pandemic in Catalonia

2021 ◽  
pp. 1-9
Author(s):  
Anna Ramos-Pachón ◽  
Álvaro García-Tornel ◽  
Mònica Millán ◽  
Marc Ribó ◽  
Sergi Amaro ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Functional Outcome ◽  
Stroke Care ◽  
Care Quality ◽  
Point Of View ◽  
Stroke Severity ◽  
Acute Stroke Care ◽  
Vessel Occlusion ◽  
Prehospital Delays ◽  
The Impact

<b><i>Introduction:</i></b> The COVID-19 pandemic resulted in significant healthcare reorganizations, potentially striking standard medical care. We investigated the impact of the COVID-19 pandemic on acute stroke care quality and clinical outcomes to detect healthcare system’s bottlenecks from a territorial point of view. <b><i>Methods:</i></b> Crossed-data analysis between a prospective nation-based mandatory registry of acute stroke, Emergency Medical System (EMS) records, and daily incidence of COVID-19 in Catalonia (Spain). We included all stroke code activations during the pandemic (March 15–May 2, 2020) and an immediate prepandemic period (January 26–March 14, 2020). Primary outcomes were stroke code activations and reperfusion therapies in both periods. Secondary outcomes included clinical characteristics, workflow metrics, differences across types of stroke centers, correlation analysis between weekly EMS alerts, COVID-19 cases, and workflow metrics, and impact on mortality and clinical outcome at 90 days. <b><i>Results:</i></b> Stroke code activations decreased by 22% and reperfusion therapies dropped by 29% during the pandemic period, with no differences in age, stroke severity, or large vessel occlusion. Calls to EMS were handled 42 min later, and time from onset to hospital arrival increased by 53 min, with significant correlations between weekly COVID-19 cases and more EMS calls (rho = 0.81), less stroke code activations (rho = −0.37), and longer prehospital delays (rho = 0.25). Telestroke centers were afflicted with higher reductions in stroke code activations, reperfusion treatments, referrals to endovascular centers, and increased delays to thrombolytics. The independent odds of death increased (OR 1.6 [1.05–2.4], <i>p</i> 0.03) and good functional outcome decreased (mRS ≤2 at 90 days: OR 0.6 [0.4–0.9], <i>p</i> 0.015) during the pandemic period. <b><i>Conclusion:</i></b> During the COVID-19 pandemic, Catalonia’s stroke system’s weakest points were the delay to EMS alert and a decline of stroke code activations, reperfusion treatments, and interhospital transfers, mostly at local centers. Patients suffering an acute stroke during the pandemic period had higher odds of poor functional outcome and death. The complete stroke care system’s analysis is crucial to allocate resources appropriately.

Abstract W MP104: Quality of Acute Stroke Care at Primary Stroke Centers Before and After Certification in Comparison to Never-Certified Hospitals

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Nerses Sanossian ◽  
May A Kim-Tenser ◽  
David S Liebeskind ◽  
Justina Breen ◽  
Scott Hamilton ◽  
...  
Keyword(s):  
Los Angeles ◽  
Acute Stroke ◽  
Stroke Care ◽  
Care Quality ◽  
Acute Stroke Care ◽  
Phase 3 ◽  
Before And After ◽  
Beneficial Impact ◽  
Mean Time

Background: Primary Stroke Centers (PSC) provide better acute stroke care than non-PSC hospitals, including faster times to imaging and lytic treatment, and higher rates of lytic delivery. Nationwide less than 1 in 3 hospital has achieved this designation. We aimed to determine the extent to which the better performance at PSC is driven by improvements within hospitals after PSC designation versus better baseline hospital care among facilities seeking PSC certification. Methods: From 2005 to 2012, the NIH Field Administration of Stroke Therapy -Magnesium (FAST-MAG) Phase 3 clinical trial enrolled subjects with likely stroke within 2 hours of onset in a study of prehospital start of a neuroprotective agent. Subjects were routed to 59 community and academic centers in Los Angeles and Orange Counties. Of the original 59 centers, 39 eventually achieved PSC status during the study period. Each subject was classified as enrolled at a PSC before certification (pre-PSC), at a PSC post certification (post-PSC), or at a hospital that never achieved PSC (non-PSC). Results: Of 1700 cases, 529 (31%) were enrolled at pre-PSC, 856 (50%) at post-PSC, and 315 (19%) at non-PSC hospitals. Mean time in minutes from ED arrival to first scan was 33 minutes at post-PSC, 47 minutes at pre-PSC and 49 at non-PSCs [p<0.001 by Mann-Whitney]. Among cases of cerebral ischemia (CI) [N=1223], rates of TPA utilization were 43% at post-PSC, 27% at pre-PSC and 28% at non-PSC hospitals [p<0.001 by X2]. Time in minutes from ED arrival to thrombolysis in treated cases was 71 at post-PSC, 98 at pre-PSC, and 95 at non-PSC hospitals [p<0.001 by Mann-Whitney]. Hospitals that achieved PSC showed improvements in pre-PSC and post-PSC performance on door to imaging time, from 47 to 33 minutes [p=0.014]; percent TPA use in CI, from 27% to 43% [p<0.001], and reduced door-to-needle times, from 98 to 71 minutes [p=0.003]. There was no difference in time to imaging [47 vs. 49 minutes], time to thrombolysis [98 vs. 95 minutes] and percent TPA use [27% vs. 28%] between pre-PSC hospitals and non-PSC hospitals. Conclusions: Better performance of Primary Stroke Centers on acute care quality metrics is primarily driven by a beneficial impact of the PSC-certification process, and not better performance prior to seeking PSC status.

Ten Years of Improving Acute Stroke Management in a Metropolitan Area: A Population-Based Quantification of Quality Indicators

2021 ◽  
pp. 1-11
Author(s):  
Anna Alegiani ◽  
Michael Rosenkranz ◽  
Leonie Schmitz ◽  
Susanne Lezius ◽  
Günter Seidel ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Quality Indicators ◽  
Metropolitan Area ◽  
Stroke Care ◽  
Care Quality ◽  
Acute Stroke Care ◽  
Stroke Units ◽  
Stroke Treatment ◽  
Acute Stroke Treatment ◽  
Over Time

<b><i>Background and Purpose:</i></b> Rapid access to acute stroke treatment improves clinical outcomes in patients with ischemic stroke. We aimed to shorten the time to admission and to acute stroke treatment for patients with acute stroke in the Hamburg metropolitan area by collaborative multilevel measures involving all hospitals with stroke units, the Emergency Medical Services (EMS), and health-care authorities. <b><i>Methods:</i></b> In 2007, an area-wide stroke care quality project was initiated. The project included mandatory admission of all stroke patients in Hamburg exclusively to hospitals with stroke units, harmonized acute treatment algorithms among all hospitals, repeated training of the EMS staff, a multimedia educational campaign, and a mandatory stroke care quality monitoring system based on structured data assessment and quality indicators for procedural measures. We analyzed data of all patients with acute stroke who received inhospital treatment in the city of Hamburg during the evaluation period from the quality assurance database data and evaluated trends of key quality indicators over time. <b><i>Results:</i></b> From 2007 to 2016, a total of 83,395 patients with acute stroke were registered. During this period, the proportion of patients admitted within ≤3 h from symptom onset increased over time from 27.8% in 2007 to 35.2% in 2016 (<i>p</i> &#x3c; 0.001). The proportion of patients who received rapid thrombolysis (within ≤30 min after admission) increased from 7.7 to 54.1% (<i>p</i> &#x3c; 0.001). <b><i>Conclusions:</i></b> Collaborative stroke care quality projects are suitable and effective to improve acute stroke care.

scholarly journals Validation of Hospital Performance Measures of Acute Stroke Care Quality. Riksstroke, the Swedish Stroke Register

2016 ◽  
Vol 46 (4) ◽  
pp. 229-234 ◽  
Author(s):  
Anna Söderholm ◽  
Birgitta Stegmayr ◽  
Eva-Lotta Glader ◽  
Kjell Asplund ◽  
Keyword(s):  
Data Quality ◽  
Acute Stroke ◽  
Stroke Care ◽  
Hospital Performance ◽  
Care Quality ◽  
Sufficient Data ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Stroke Register ◽  
Care Performance

Background: Registers are increasingly used to monitor stroke care performance. Fair benchmarking requires sufficient data quality. We have validated acute care data in Riksstroke, the Swedish Stroke Register. Methods: Completeness was assessed by comparisons with diagnoses at hospital discharge recorded in the compulsory National Patient Register and content validity by comparisons with (a) key variables identified by European stroke experts, and (b) items recorded in other European stroke care performance registers. Five test cases recorded by 67 hospitals were used to estimate inter-hospital reliability. Results: All 72 Swedish hospitals admitting acute stroke patients participated in Riksstroke. The register was estimated to cover at least 90% of acute stroke patients. It includes 18 of 22 quality indicators identified by international stroke experts and 14 of 15 indicators used by at least 2 stroke performance registers in other European countries. Inter-hospital reliability was high (≥85%) in 77 of 81 Riksstroke items. Conclusions: A nationwide stroke care register can be maintained with sufficient data quality to permit between-hospital performance benchmarking. Our experiences may serve as a model for other stroke registers while evaluating data quality.

Accessibility to Tertiary Stroke Centers in Hokkaido, Japan: Use of Novel Metrics to Assess Acute Stroke Care Quality

2018 ◽  
Vol 27 (1) ◽  
pp. 177-184 ◽  
Author(s):  
Kensuke Fujiwara ◽  
Toshiya Osanai ◽  
Eiichi Kobayashi ◽  
Takumi Tanikawa ◽  
Ken Kazumata ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Care Quality ◽  
Acute Stroke Care

scholarly journals Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months

2020 ◽  
pp. svn-2020-000332
Author(s):  
Yi Sui ◽  
Jianfeng Luo ◽  
Chunyao Dong ◽  
Liqiang Zheng ◽  
Weijin Zhao ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Stroke ◽  
Urban Area ◽  
Acute Ischaemic Stroke ◽  
Urban Areas ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Care Quality ◽  
Acute Stroke Care ◽  
Tertiary Hospitals

BackgroundThe rate of intravenous thrombolysis for acute ischaemic stroke remains low in China. We investigated whether the implementation of a citywide Acute Stroke Care Map (ASCaM) is associated with an improvement of acute stroke care quality in a Chinese urban area.MethodsThe ASCaM comprises 10 improvement strategies and has been implemented through a network consisting of 20 tertiary hospitals. We identified 7827 patients with ischaemic stroke admitted from April to October 2017, and 506 patients underwent thrombolysis were finally included for analysis.ResultsCompared with ‘pre-ASCaM period’, we observed an increased rate of administration of tissue plasminogen activator within 4.5 hours (65.4% vs 54.5%; adjusted OR, 1.724; 95% CI 1.21 to 2.45; p=0.003) during ‘ASCaM period’. In multivariate analysis models, ‘ASCaM period’ was associated with a significant reduction in onset-to-door time (114.1±55.7 vs 135.7±58.4 min, p=0.0002) and onset-to-needle time (ONT) (169.2±58.1 vs 195.6±59.3 min, p<0.0001). Yet no change was found in door-to-needle time. Clinical outcomes such as symptomatic intracranial haemorrhage, favourable functional outcome (modified Rankin Scale ≤2) and in-hospital mortality remained unchanged.ConclusionThe implementation of ASCaM was significantly associated with increased rates of intravenous thrombolysis and shorter ONT. The ASCaM may, in proof-of-principle, serve as a model to reduce treatment delay and increase thrombolysis rates in Chinese urban areas and possibly other highly populated Asian regions.

Abstract 303: A Novel Multi-modal Approach to Stroke Care Quality Improvement and The Development of High-performing Stroke Care Teams

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Mark O Loveless ◽  
Aaron Kamauu
Keyword(s):  
Quality Improvement ◽  
Acute Stroke ◽  
Path Analysis ◽  
Clinical Outcomes ◽  
Critical Path ◽  
Stroke Care ◽  
Care Quality ◽  
Care Team ◽  
Care Process ◽  
Acute Stroke Care

Background: The clinical outcomes and quality of care in acute ischemic stroke (AIS) are time-dependent and influenced by the effectiveness and efficiency of the care delivery system. Much attention has been given to improving process and procedure; however, the structure and inter[[Unable to Display Character: &#8208;]]dependencies of the stroke care teams must be integrated into any acute stroke care quality improvement process. Objective: The objective of this study was to apply an innovative multi[[Unable to Display Character: &#8208;]]modal analytic approach that combines formal epidemiologic analysis, process evaluation and social network modeling of stroke care teams to describe and improve the critical system characteristics of high[[Unable to Display Character: &#8208;]]performing units in real[[Unable to Display Character: &#8208;]]world hospital systems. Methods: Characteristics of individual hospital units, as well as variation of treatment delivery, were analyzed and compared. A critical path analysis was created based on a widely adopted acute stroke care process model. Stroke care team structures and inter[[Unable to Display Character: &#8208;]] dependencies were mapped based on the responses to a survey and the responses were analyzed using open[[Unable to Display Character: &#8208;]]source network graphing software. Results: The care team networks were overlaid on to the corresponding process pathways to create a final synthesis of the process and team structure (example below). Critical path analysis combined with mapping of the individual stroke team network interactions demonstrated additional associations between the team structures and process/clinical outcomes. Opportunities for improvement in both process and personnel organization were identified and integrated into existing CQI efforts. Conclusion: Multi[[Unable to Display Character: &#8208;]]modal systems analysis incorporating both care process and stroke care team inter[[Unable to Display Character: &#8208;]]dependencies offers an enhanced approach to integrated quality improvement for acute stroke care.

scholarly journals Weekly variation in health-care quality by day and time of admission: a nationwide, registry-based, prospective cohort study of acute stroke care

The Lancet ◽  
2016 ◽  
Vol 388 (10040) ◽  
pp. 170-177 ◽  
Author(s):  
Benjamin D Bray ◽  
Geoffrey C Cloud ◽  
Martin A James ◽  
Harry Hemingway ◽  
Lizz Paley ◽  
...  
Keyword(s):  
Health Care ◽  
Cohort Study ◽  
Acute Stroke ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Health Care Quality ◽  
Stroke Care ◽  
Care Quality ◽  
Acute Stroke Care ◽  
Time Of Admission
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