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.

scholarly journals Effects of centralizing acute stroke services

Neurology ◽  
2018 ◽  
Vol 91 (3) ◽  
pp. e236-e248 ◽  
Author(s):  
Sidsel Hastrup ◽  
Soren P. Johnsen ◽  
Thorkild Terkelsen ◽  
Heidi H. Hundborg ◽  
Paul von Weitzel-Mudersbach ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Acute Stroke ◽  
Stroke Care ◽  
Acute Hospital ◽  
Acute Stroke Care ◽  
Difference In Differences ◽  
Stroke Units ◽  
Before And After ◽  
Stroke Services

ObjectiveTo investigate the effects of centralizing the acute stroke services in the Central Denmark Region (CDR).MethodsThe CDR (1.3 million inhabitants) centralized acute stroke care from 6 to 2 designated acute stroke units with 7-day outpatient clinics. We performed a prospective “before-and-after” cohort study comparing all strokes from the CDR with strokes in the rest of Denmark to discover underlying general trends, adopting a difference-in-differences approach. The population comprised 22,141 stroke cases hospitalized from May 2011 to April 2012 and May 2013 to April 2014.ResultsCentralization was associated with a significant reduction in length of acute hospital stay from a median of 5 to 2 days with a length-of-stay ratio of 0.53 (95% confidence interval 0.38–0.75, data adjusted) with no corresponding change seen in the rest of Denmark. Similarly, centralization led to a significant increase in strokes with same-day admission (mainly outpatients), whereas this remained unchanged in the rest of Denmark. We observed a significant improvement in quality of care captured in 11 process performance measures in both the CDR and the rest of Denmark. Centralization was associated with a nonsignificant increase in thrombolysis rate. We observed a slight increase in readmissions at day 30, but this was not significantly different from the general trend. Mortality at days 30 and 365 remained unchanged, as in the rest of Denmark.ConclusionsCentralizing acute stroke care in the CDR significantly reduced the length of acute hospital stay without compromising quality. Readmissions and mortality stayed comparable to the rest of Denmark.

scholarly journals Quality of Acute Stroke Care at Primary Stroke Centers Before and After Certification in Comparison to Never-Certified Hospitals

2020 ◽  
Vol 10 ◽  
Author(s):  
Kristina Shkirkova ◽  
Theodore T. Wang ◽  
Lily Vartanyan ◽  
David S. Liebeskind ◽  
Marc Eckstein ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Before And After

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.

FP22-TU-01 Quality of acute stroke care in Thailand, a prospective multicenter countrywide study

2009 ◽  
Vol 285 ◽  
pp. S91
Author(s):  
Y. Nilanont ◽  
S. Nidhinandana ◽  
N. Suwanwela ◽  
N. Poungvarin
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Acute Stroke Care

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 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 The Dutch Acute Stroke Audit: Benchmarking acute stroke care in the Netherlands

2018 ◽  
Vol 3 (4) ◽  
pp. 361-368 ◽  
Author(s):  
Laurien S Kuhrij ◽  
Michel WJM Wouters ◽  
Renske M van den Berg-Vos ◽  
Frank-Erik de Leeuw ◽  
Paul J Nederkoorn
Keyword(s):  
Acute Stroke ◽  
Best Practice ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Favourable Outcome ◽  
Hospital Level ◽  
Acute Stroke Care ◽  
Related Factors ◽  
Variation In Care

Introduction In the nationwide Dutch Acute Stroke Audit (DASA), consecutive patients with acute ischaemic stroke (AIS) and intracranial haemorrhage (ICH) are prospectively registered. Acute stroke care is a rapidly evolving field in which intravenous thrombolysis (IVT) and intra-arterial thrombectomy (IAT) play a crucial role in increasing odds of favourable outcome. The DASA can be used to assess the variation in care between hospitals and develop ‘best practice’ in acute stroke care. Patients and methods: We describe the initiation and design of the DASA as well as the results from 2015 and 2016. Results In 2015 and 2016, 55,854 patients with AIS and 7727 patients with ICH were registered in the DASA. Treatment with IVT was administered to 10,637 patients (with an increase of 1.3% in 2016) and 1740 patients underwent IAT (with an increase of 1% in 2016). Median door-to-needle time for IVT and median door-to-groin time for IAT have decreased from 27 to 25 min and 66 to 64 min, respectively. Mortality during admission was 4.9% in patients with AIS, whereas 26% of patients with ICH died. Modified Rankin Scale score at three months was registered in 49% of AIS patients and 45% of ICH patients. Discussion During the nationwide DASA, time to treatment is reduced for IVT as well as IAT. With the rapidly evolving treatment of acute stroke care, the DASA can be used to monitor the quality provided on patient- and hospital level. Conclusion Increasing completeness of registration of the outcome, in combination with adjustment for patient-related factors, is necessary to define and further improve the quality of the acute stroke care.

Abstract 2317: A Multidisciplinary Team Approach to Improving Laboratory Results and Thrombolytic Treatment in Acute Code Stroke Patients.

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Debbie Tay ◽  
Connie Boyd ◽  
Andrew Imbus ◽  
Arbi Ohanian ◽  
Jessica Graves ◽  
...  
Keyword(s):  
Los Angeles ◽  
Acute Stroke ◽  
Median Time ◽  
Stroke Care ◽  
Lean Six Sigma ◽  
Phase Iii ◽  
Team Approach ◽  
Medical Systems ◽  
Acute Stroke Care ◽  
The Past

Despite improvement in acute stroke care, stroke remains the third major cause of death and leading cause of disability nationwide. An increase in the number of certified Primary Stroke Centers (PSC) over the past years has been credited for the improvement. Los Angeles County proactively implemented the Approved Stroke Center Network in which Emergency Medical Systems may passes non-certified PCS for acute stroke treatments. Our hospital’s journey towards building a stroke program began in early 2008, and in 2009 a CODE STROKE algorithm was implemented. Over the past two years, the team has strived to continuously improve ‘door to needle’ times. Opportunity to improve door-to-lab results was recognized so we sought to investigate and identify barrier(s)/reason(s) for delays. Methods The LEAN Six Sigma team guided our multidisciplinary committee for identifying contributing delays. A review of the clinical pathway from the patient’s arrival time (door) and activation of Code Stroke are time-stamped at every step. Phase I identified delays with phlebotomist transit times. The laboratory management addressed this issue by reinforcing the need to expedite the specimen collection, transit time and processing. Some improvement was noted in the door-to-lab results time but significant delays remained a problem. Phase II incorporated lab draws being performed prior to the patient going for their CT scan. Phase III involves utilization of an iStat unit within the emergency department for analysis of a CHEM 8 panel. Results Analysis of data initially showed door-to-lab results had a median time of 52 minutes, with 38% having results within 45 minutes. Ten patients received tPA within median times of 66 minutes, with 53% receiving tPA within 60 minutes. In 2010 action plans initiated yielded significant improvements with door-to-lab results median times of 44 minutes, 64% having lab results within 45 minutes. Twenty one patients received tPA within a median time of 55 minutes, and 70% having received tPA within 60 minutes. Conclusion The multidisciplinary stroke team identified barriers and implemented process changes yielding improvements in door-to-lab results that in turn resulted in overall improvements in tPA treatment times. Data collection and process evaluation continue.

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.

scholarly journals Stroke care in Italy: An overview of strategies to manage acute stroke in COVID-19 time

2020 ◽  
Vol 5 (3) ◽  
pp. 222-229 ◽  
Author(s):  
Marialuisa Zedde ◽  
Francesca Romana Pezzella ◽  
Maurizio Paciaroni ◽  
Francesco Corea ◽  
Nicoletta Reale ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Care Pathways ◽  
National Guidelines ◽  
Acute Stroke Care ◽  
Treatment Pathways ◽  
Delivery Of Care ◽  
Stroke Treatment ◽  
Italian Regions ◽  
Before And After

Purpose To analyse structural and non-structural modifications of acute stroke care pathways undertaken at healthcare institutions across the regions of Italy due to the coronavirus disease 2019 (COVID-19) pandemic. Methods Research on National decrees specific for the pandemic was carried out. The stroke pathways of four Italian regions from North to South, such as Lombardy, Veneto, Lazio and Campania, were analysed before and after the pandemic outbreak. Findings On 29 February 2020, the Italian Minister of Health issued national guidelines on how to address the COVID-19 emergency. Stroke management was affected and required changes, basically resulting in the need to prioritise the ongoing COVID-19 emergency. In the most affected regions, the closure of departments and hospitals led to a complete reorganisation of previously functioning stroke networks. With the closure of several Stroke Units and Stroke Centres, the transportation time to hospital lengthened significantly, especially for the outlying populations. Discussion The COVID-19 pandemic outbreak has been spreading rapidly in Italy and placing an overwhelming burden on healthcare systems. In response to this, political and healthcare decision-makers worked together to develop and implement efforts to sustain the national healthcare system while fighting the pandemic. Stroke care pathways changed during the pandemic and different organisational models were applied in the most affected regions. Conclusions Stroke treatment pathways will need to be redesigned so to guarantee that severe and acute disease patients do not lose their rights to the access and delivery of care during the COVID-19 pandemics.

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