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Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide

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Development of performance measures for acute ischemic stroke.

R G Holloway¹, B G Vickrey, C Benesch

¹Department of Neurology, University of Rochester School of Medicine, NY, USA. bholloway@mct.rochester.edu

|September 8, 2001

Summary

This study developed and rated performance measures for acute ischemic stroke care in hospitals. Key measures for improving stroke outcomes were identified and agreed upon by a multidisciplinary panel.

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Area of Science:

Neurology
Healthcare Quality Improvement
Clinical Performance Measurement

Background:

Developing robust performance measures is crucial for enhancing hospital-based acute ischemic stroke care.
Standardized metrics are needed to assess and improve the quality of stroke treatment pathways.

Framework:

A national multidisciplinary panel developed 44 potential stroke performance measures.
Measures were evaluated using a modified Delphi approach across six quality dimensions: evidence validity, feasibility, impact, room for improvement, plausibility, and overall rating.

Implementation:

The panel identified highly rated measures including warfarin for atrial fibrillation, antithrombotics at discharge, carotid imaging, and stroke unit utilization.
Heparin for DVT prophylaxis and stroke protocols also showed high agreement among panelists.
Time-sensitive thrombolytic measures received high ratings for potential improvement but lower overall scores.

Implications:

Validated performance measures exist for all aspects of hospital stroke care, facilitating quality improvement initiatives.
These measures can guide clinical practice and policy to optimize patient outcomes in acute ischemic stroke.
Further research may refine thrombolytic management protocols based on panel feedback.