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Enhancing acute stroke care in Ireland: A scoping review and Delphi consensus for the Irish National Audit of Stroke
Catherine Nora Moran1, Isabelle Jeffares2, Joan McCormack3
1School of Population Health, RCSI, Dublin, Leinster, Ireland catherinenmoran@rcsi.ie.
Objectives:
To develop an updated core dataset for acute stroke care in Ireland, informed by international audit benchmarking and national stakeholder consensus, for integration into the Irish National Audit of Stroke (INAS).
Design:
Scoping review and three-round Delphi process.
Data Sources:
Medline Ovid, Embase, CINAHL EBSCOhost, Google Scholar, audit websites and grey literature (2010-2024). Additional audit documentation was obtained via direct author contact.
Eligibility Criteria For Selecting Studies:
National stroke audits or registries with a country-wide scope, ≥1 year of continuous data collection and active in 2021 were eligible. Only audits covering acute stroke care were included in this study phase. All records were screened for inclusion.
Data Extraction And Synthesis:
Audit documentation (data dictionaries, item definitions and contextual metadata) was retrieved from eligible audits. Acute stroke care items were extracted, charted and benchmarked against existing INAS items and each other to identify commonalities and gaps. Frequently collected international items (appearing in ≥4 audits/registries) were shortlisted. A three-round Delphi process with 24 national stakeholders (clinicians, nurses, allied health professionals, researchers, policymakers and patient representatives) was conducted to audit and refine the dataset through structured, anonymised item rating, iterative feedback and consensus-building discussions.
Results:
Twenty-one eligible international stroke audits/registries were identified, yielding ~4500 audit items. Benchmarking against existing INAS items (n=103), frequently collected international items (n=97) and expert-suggested items (n=22) informed the Delphi consultation. The final dataset expanded INAS by 18 items, totalling 86 acute care and 35 thrombectomy-specific items. New additions included stroke-related complications and risk factor documentation.
Conclusions:
This structured, consensus-led process resulted in an internationally benchmarked, stakeholder-informed core dataset to enhance standardised stroke auditing in Ireland. The expanded dataset supports enhanced clinical monitoring, quality improvement and health system planning. This approach may inform audit development and research efforts in other contexts.
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