Protocols for ischaemic stroke in Flemish hospitals: correlation between availability and content versus adherence

Stroke is globally one of the leading causes of mortality and disability. Adhering to evidence-based guidelines and protocols can improve the quality of care for ischaemic stroke patients. We aimed to compare the availability and content of specific protocols versus adherence to these key interventions in clinical daily practice among Flemish hospitals. We selected five key interventions for managing ischaemic stroke patients. These key interventions encompassed the measurement of body temperature, glycaemia monitoring, screening of swallowing function according to the Fever, Sugar, and Swallowing protocol (FeSS protocol), depression screening, and activities of daily living (ADL) screening (FeSS+ key interventions).

A systematic quantitative and qualitative approach was designed to analyse specific protocols from 24 hospitals. A predefined data extraction matrix for the five FeSS+ key interventions was utilized for data collection. Using this matrix, protocols were scored according to the completeness of content, regarding the FeSS+ interventions. These scores were used to calculate a total protocol content score, i.e. a total score for the five FeSS+ interventions and an individual score for each key intervention separately, ranging between 0 and 1, per hospital. A score of 0 indicates absence of the FeSS+ interventions in the protocols, while a score of 1 signifies complete coverage of these interventions. In addition, we assessed the correlation between the availability and content of these protocols in relation to the adherence to interventions documented for 30 patients per hospital.

The mean total protocol content score was 0.40 ± 0.20, ranging from 0.64 ± 0.25 for glycaemia management to 0.1 ± 0.28 for ADL screening. With regard to the individual FeSS+ key interventions, we identified a correlation between protocol characteristics and adherence for glycaemia (rs = 0.42, P = .04), depression screening (rs = 0.43, P = .04), and ADL screening (rs = 0.44, P = 0.03). Total FeSS+-protocol content also correlated with adherence (r = 0.6140, P = .0014).

Protocol characteristics for the FeSS+ key interventions were variable and rather limited, especially for ADL and depression screening. The identified relationship between the content of protocols and adherence to interventions underscores the value of defining these activities in hospital documentation to improve stroke care.