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External quality monitoring facilitates improvement in already well-performing stroke units: insights from RES-Q Poland. | LitMetric

AI Article Synopsis

  • The RES-Q system in Poland assesses stroke care quality, focusing on improvements in hospitals involved in the Angels Initiative from 2017 to 2020.
  • Out of 180 stroke units, 17 consistently reported patient data, showing stable alteplase treatment rates but a significant decrease in door-to-needle time and improved treatment times for patients.
  • Despite advancements in some areas of stroke care, issues remain, including lower early dysphagia screening rates and an increase in in-hospital mortality, signaling a need for ongoing monitoring and improvement.

Article Abstract

Introduction: The Registry of Stroke Care Quality (RES-Q) is used in Poland for quality monitoring by numerous hospitals participating in the Angels Initiative. Our aim was to assess the degree of improvement in highly stroke-oriented centres that report cases to the RES-Q each year.

Material And Methods: This retrospective analysis included Polish stroke units that from January 2017 to December 2020 contributed to the RES-Q at least 25 patients annually.

Results: Seventeen out of 180 Polish stroke units reported patients each year (2017, n = 1,691; 2018, n = 2,986; 2019, n = 3,750; 2020, n = 3,975). The percentage of ischaemic stroke patients treated with alteplase remained stable (26%, 29%, 30% and 28%, respectively). The door-to-needle time progressively decreased, from a median 49 minutes to 32 minutes. The percentage of patients treated ≤ 60 minutes and ≤ 45 minutes significantly increased (from 68% to 86% and from 43% to 70%, respectively), with no change observed between 2019 and 2020. Despite a general improvement in dysphagia screening (81%, 91%, 98% and 99%), screening performed within the first 24h from admission became less frequent (78%, 76%, 69% and 65%). In-hospital mortality significantly increased (11%, 11%, 13% and 15%), while the proportion of patients discharged home remained stable.

Conclusions: Quality-oriented projects facilitate the improvement of stroke care, even in centres demonstrating good baseline performance. Polish stroke units that consistently reported cases to the RES-Q demonstrated improvement in terms of door-to- -needle time and dysphagia screening. However, there is still a need to shorten the time to dysphagia screening, and carefully monitor stroke unit mortality following the COVID-19 pandemic.

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Source
http://dx.doi.org/10.5603/pjnns.96442DOI Listing

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