stroke care
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2022 ◽  
Vol 20 ◽  
pp. 100358
Stephanie G. Thompson ◽  
P. Alan Barber ◽  
John H. Gommans ◽  
Dominique A. Cadilhac ◽  
Alan Davis ◽  

Layne Dylla ◽  
John D. Rice ◽  
Sharon N. Poisson ◽  
Andrew A. Monte ◽  
Hannah M. Higgins ◽  

Rohini Bhole ◽  
Angela M. Sales ◽  
Anupam Lahiri ◽  
Lauren Knight ◽  
Robin J. Womeodu ◽  

2022 ◽  
Vol 7 (4) ◽  
pp. 301-305
Thomas Iype ◽  
Dileep Ramachandran ◽  
Praveen Panicker ◽  
Sunil D ◽  
Manju Surendran ◽  

Worldwide stroke care was affected by COVID 19 pandemic and the majority of the literature was on ischemic stroke. Intracerebral hemorrhage (ICH) accounts for about one-fourth of strokes worldwide and has got high mortality and morbidity. We aimed to study the effect of the Pandemic on ICH outcomes and flow metrics during the first wave compared to the pre-pandemic period and how that experience was made used in managing ICH during the second wave. Ours was a single-center observational study, where consecutive patients with non-COVID spontaneous ICH aged more than 18 years who presented within 24 hours of last seen normal were included in the study. We selected the months of June, July, and August in 2021 as the second wave of the pandemic, the same months in 2020 as the first wave of the pandemic, and the same months in 2019 as the pre-pandemic period. We compared the 3-month functional outcomes, in hospital mortality and workflow metrics during the three time periods. We found poor three-month functional outcomes and higher hospital mortality during the first wave of the COVID 19 pandemic, which improved during the second wave. In-hospital time metrics measured by the door to CT time which was delayed during the first wave improved to a level better than the pre-pandemic period during the second wave. ICH volume was more during the first and second waves compared to the pre-pandemic period. Other observations of our study were younger age during the second wave and higher baseline systolic BP at admission during both pandemic waves. Our study showed that functional outcomes and flow metrics in ICH care improved during the second wave of the pandemic through crucial re-organization of hospital stroke workflows. We are sharing this experience because we may have to do further rearrangements in future as the upcoming times are challenging due to new variants emerging.

2022 ◽  
Meilka Jameie ◽  
Mana Jameie ◽  
Ghasem Farahmand ◽  
Saba Ilkhani ◽  
Hana Magrouni ◽  

Abstract Background and objectiveDoor-to-needle (DTN) time is an important factor in stroke settings for which studies have reported delays in women, resulting in worse stroke outcomes. We aimed to evaluate whether our modified algorithm could reduce sex disparities, especially in DTN.MethodsThis longitudinal cohort study was conducted between September 1, 2019, and August 31, 2021, at a comprehensive stroke center. Previously we utilized the conventional “D’s of stoke care” for timely management. The “modified 8 D’s of stroke care” was designed by our team in September 2020. Patients were analyzed in two groups: group 1, before, and group 2, after employing the modified algorithm. Sex as the main variable of interest along with other selected covariates were regressed towards the DTN, using univariable and multivariable logistic regressions.ResultsWe enrolled 47 and 56 patients who received intravenous thrombolysis (IVT) in groups 1 and 2, respectively. Although there was a significant difference in DTN≤ 1 hour in group 1 (36% of females vs. 52% of males, p= 0.019), it was not significantly different in group 2 anymore (48% of females vs. 48.4% of males, p= 0.97). Furthermore, regression analysis showed being female was a significant predictor of DTN> 1 hour in group 1 (aOR= 6.65, p= 0.02), while after the modified algorithm gender was not a predictor of delayed DTN anymore.ConclusionAlthough we have a long way to achieve performance measures in developed countries, we seem to have succeeded in reducing gender disparities in DTN using the modified algorithm.

2022 ◽  
pp. 197140092110674
Nick M Murray ◽  
Phillip Phan ◽  
Greg Hager ◽  
Andrew Menard ◽  
David Chin ◽  

The first ever insurance reimbursement for an artificial intelligence (AI) system, which expedites triage of acute stroke, occurred in 2020 when the Centers for Medicare and Medicaid Services (CMS) granted approval for a New Technology Add-on Payment (NTAP). Key aspects of the AI system that led to its approval by the CMS included its unique mechanism of action, use of robotic process automation, and clear linkage of the system’s output to clinical outcomes. The specific strategies employed encompass a first-case scenario of proving reimbursable value for improved stroke outcomes using AI. Given the rapid change in utilization of AI technology in stroke care, we describe the economic drivers of stroke AI systems in healthcare, focusing on concepts of reimbursement for value added by AI to the stroke care system. This report reviews (1) the successful approach used by the first NTAP-approved AI system, (2) economic variables in insurance reimbursement for AI, and (3) resultant strategies that may be utilized to facilitate qualification for NTAP reimbursement, which may be adopted by other AI systems used in stroke care.

2022 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Bianca Buijck ◽  
Bert Vrijhoef ◽  
Monique Bergsma ◽  
Diederik Dippel

PurposeTo organize stroke care, multiple stakeholders work closely together in integrated stroke care services (ISCS). However, even a well-developed integrated care program needs a continuous quality improvement (CQI) cycle. The current paper aims to describe the development of a unique peer-to-peer audit framework, the development model for integrated care (DMIC), the Dutch stroke care standard and benchmark indicators for stroke.Design/methodology/approachA group of experts was brought together in 2016 to discuss the aims and principles of a national audit framework. The steering group quality assurance (SGQA) consisted of representatives of a diversity of professions in the field of stroke care in the Netherlands, including managers, nurses, medical specialists and paramedics.FindingsAuditors, coordinators and professionals evaluated the framework, agreed on that the framework was easy to use and valued the interesting and enjoyable audits, the compliments, feedback and fruitful insights. Participants consider that a quality label may help to overcome necessity issues and have health care insurers on board. Finally, a structured improvement plan after the audit is needed.Originality/valueAn audit offers fruitful insights into the functioning of an ISCS and the collaboration therein. Best practices and points of improvement are revealed and can fuel collaboration and the development of partnerships. Innovative cure and care may lead to an increasing area of support among professionals in the ISCS and consequently lead to improved quality of delivered stroke care.

2022 ◽  
pp. 174749302110664
Tamer Roushdy ◽  
Hany Aref ◽  
Selma Kesraoui ◽  
Michael Temgoua ◽  
Kiatoko Ponte Nono ◽  

Background: Over the past few years, the incidence and prevalence of stroke has been rising in most African countries and has been reported as one of the leading causes of morbidity and mortality. To study this problem, we need to realize the quality and availability of stroke care services as a priori to improve them. Methods and Results: In this study, we investigated the availability of different stroke-related services in 17 countries from different African regions. An online survey was conducted and fulfilled by stroke specialists and included primary prevention, acute management, diagnostic tools, medications, postdischarge services, and stroke registries. The results showed that although medications for secondary prevention are available, yet many other services are lacking in various countries. Conclusion: This study displays the deficient aspects of stroke services in African countries as a preliminary step toward active corrective procedures for the improvement of stroke-related health services.

2022 ◽  
Vol 11 (1) ◽  
pp. e001429
Jennifer Hennebry ◽  
Sinead Stoneman ◽  
Breda Jones ◽  
Nicola Bambrick ◽  
Andreea Stroiescu ◽  

This paper describes a stroke quality improvement (QI) project in a primary stroke centre in a 431-bed hospital serving a local population of 114 000 people. Approximately 170 acute strokes are treated each year in a seven-bed stroke unit managed by three geriatricians with a subspecialty interest in stroke. 24-hour CT radiology service is available. Endovascular thrombectomy (EVT) is performed by neuro-interventional radiology at one of two comprehensive stroke centres located 90–120 min away.In 2018, as part of a national collaborative QI initiative a new national thrombectomy referral pathway was introduced with an aim that all eligible patients be referred for EVT. This initiative included maximising timely access to CT and thrombolysis. Review of local data highlighted significant deficits in these areas.A local QI team convened and a multidisciplinary approach was employed to map the existing process for CT access and time to thrombolysis decision.We describe how focused timesaving interventions such as; new emergency and radiology department ‘pre-alerts’, dedicated acute stroke pagers, new ‘FAST’ registration by clerical staff, new CT ordering codes and new ‘FAST packs’ (including tissue plasminogen activator, paper National Institute of Health Stroke Scale scoring tools, consent forms and EVT patient selection tools) were created and incorporated into a multidisciplinary detailed clinical stroke care pathway.We describe how we achieved our SMART aims; to reduce our door to CT time and to reduce our door to needle time to the national target of less than 30 min. A third aim was to increase the number of patients referred for EVT from our centre.This project is an accurate description of how a multidisciplinary approach combined with teamwork and effective communication can create sustainable improved patient care and is generalisable to all institutions that require timely referral to external centres for EVT.

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