In-Hospital Versus Out-of-Hospital Stroke Onset Comparison of Process Metrics in a Community Primary Stroke Center

Area of Science:

• Neurology
• Emergency Medicine
• Healthcare Quality

Background:

• Stroke care quality varies significantly based on onset location.
• Timely intervention is critical for improving stroke outcomes.
• Community primary stroke centers face challenges in managing in-hospital stroke alerts.

Purpose of the Study:

• To compare in-hospital versus out-of-hospital stroke onset metrics.
• To evaluate quality of care and mortality rates between the two groups.
• To identify areas for improvement in stroke management within a primary stroke center.

Main Methods:

• Retrospective analysis of medical records and stroke alert data (2013-2019).
• Comparison of time-sensitive stroke process metrics between in-hospital and out-of-hospital stroke groups.
• Statistical analysis using Kruskal-Wallis and chi-squared tests (α=0.05).

Main Results:

• Out-of-hospital strokes showed faster median stroke team response (15.0 vs 26.0 min) and head CT completion (12.0 vs 41.0 min).
• In-hospital strokes had longer hospital stays (4 vs 3 days) and higher mortality (19.3% vs 7.4%).
• No significant difference in initial stroke alert time was observed between groups.

Conclusions:

• Out-of-hospital stroke care demonstrated superior time-sensitive process metrics and outcomes.
• In-hospital stroke management requires optimization of time-sensitive processes.
• Focusing on improving these metrics could enhance outcomes for in-hospital stroke patients.