Evaluation of a service development to implement the top three process indicators for quality stroke care

Stroke mortality remains unacceptably high with up to 30% of patients dying within 1 month. Early swallow screen and computerized tomography (CT) brain scan, facilitate delivery of aspirin, which together are recognized as the top three process indicators for quality stroke care. Evidence indicates that treatment with aspirin (300 mg) saves lives and should commence within 48 h of stroke onset. However, many hospitals find it difficult to meet this timescale. We aimed to evaluate whether reorganization of services could improve aspirin delivery following acute ischaemic stroke.

A retrospective audit was carried out to determine the time to swallow screen, CT scan and aspirin administration. A service review was conducted and the findings disseminated. A decision was made to reorganize services by enhancing the role of senior nursing staff to: (1) admit patients, (2) request CT brain scans, (3) screen for swallowing abnormality, and (4) prescribe the first dose of aspirin. A second audit was conducted to evaluate the impact of the new service.

Before reorganization, 30% had swallowing screened and 38% had CT scans within 24 h. Thirty-one per cent received their first dose of aspirin within 48 h. After reorganization, 68% had their swallowing screened and 80% had a CT scan within 24 h. Ninety per cent of patients received their first dose of aspirin within 48 h.

Modernizing service delivery by changing traditional roles can offer quality solutions ensuring that aspirin delivery is expedited by early swallow screen and CT scan. These initiatives could be used more widely to improve patient care and implement the top three process indicators for stroke.