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Quality benchmarks for chest pain units and stroke units in Germany
Frank Breuckmann1, Matthias Hochadel2, Armin J Grau3
1Department of Cardiology, Herz-Jesu-Krankenhaus Dernbach, Südring 8, 56428, Dernbach, Germany. f.breuckmann@krankenhaus-dernbach.de.
Insights
Chest pain units (CPUs) and stroke units (SUs) offer specialized care. Benchmarking shows CPUs have faster interventions and shorter stays, while both units demonstrate effective treatments and low mortality rates for acute chest pain and stroke.
Area of Science:
- Cardiology
- Neurology
- Health Services Research
Background:
- Chest pain units (CPUs) and stroke units (SUs) provide specialized multidisciplinary in-hospital management for acute chest pain and ischemic stroke.
- Quality benchmarking is crucial for these specialized units, especially with recent changes in emergency medicine reimbursement in Germany.
Purpose of the Study:
- To analyze and compare exemplary equivalent quality benchmarks between Chest Pain Units (CPUs) and Stroke Units (SUs).
- To identify areas for process improvement and gap analysis through joint quality measurement.
Main Methods:
- Comparative analysis of data from the German CPU registry (2012-2015) and the Stroke Unit registry of Rhineland-Palatinate (2011-2015).
- Inclusion of parameters such as demographics, symptoms, diagnosis, medication, critical time intervals, therapeutics, and in-unit outcomes.
Main Results:
- Non-ST-segment elevation myocardial infarction (47.4%) and ischemic stroke (63.0%) were the most frequent conditions treated.
- CPUs demonstrated faster electrocardiogram (7 min) and intervention times (42 min) compared to SUs (49 min for cranial imaging).
- Both units showed high rates of indicated therapies (e.g., antiplatelet therapy 90.1% vs. 96.0%) and low mortality rates (0.8% for CPUs vs. 3.6% for SUs), with CPUs having a shorter length of stay (1.5 days vs. 4.4 days).
Conclusions:
- Quality benchmarking in specialized units like CPUs and SUs is increasingly important.
- Mandatory joint quality measurement is encouraged to ensure gap analysis and facilitate process improvement in the management of acute chest pain and stroke.
Background:
Chest pain units (CPUs) and stroke units (SUs) provide specialized multidisciplinary in-hospital management for acute chest pain and ischemic stroke. We analyzed exemplary equivalent quality benchmarks in both concepts.
Material And Methods:
Data from the German CPU registry (2012-2015; 45 certified CPUs, 5881 patients) were compared with data from the SU registry of Rhineland-Palatinate (2011-2015; 29 SUs; 40,380 patients). Parameters comprised demographics, symptoms, diagnosis, medication, critical time intervals, therapeutics, and in-unit outcome.
Results:
Non-ST-segment elevation myocardial infarction (47.4%) and ischemic stroke (63.0%) were the most frequent entities. An electrocardiogram was performed on average within 7 min in CPUs, cranial imaging within 49 min in SUs. The mean time interval from admission until coronary intervention or lysis was 42 min or 57 min, respectively. Rates of antiplatelet therapy (90.1% vs. 96.0%), brain imaging, and coronary angiography were high (99.3% vs. 81.1%) and the mortality was low (0.8% for CPUs vs. 3.6% for SUs). The length of stay was shorter in CPUs (1.5 days vs. 4.4 days).
Conclusion:
As reimbursement for emergency medicine in Germany was recently rearranged, quality benchmarking has gained incremental importance. Mandatory joint quality measurement in both concepts ensuring gap analysis and process improvement is encouraged.
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