Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland.
Midwest Intern Training Programme, University Hospital Limerick, Limerick, Ireland.
Ir J Med Sci. 2022 Apr;191(2):895-899. doi: 10.1007/s11845-021-02561-y. Epub 2021 Mar 16.
We aimed to assess stroke care at an Irish university teaching hospital and benchmark against national (Irish National Audit of Stroke 2019) and international (6th SSNAP Annual Report; American Heart Association, 2013) practice to inform a quality improvement strategy.
All patients with a HIPE discharge diagnosis of Cerebral Infarction or Cerebral Haemorrhage (1 January to 31 December 2019) were identified through both the HIPE database and the institutional Stroke Portal.
A total of 419 patients were included (56.6% male, mean age 72). The following were comparable/better than findings from the Irish National Audit of Stroke: median duration of symptoms-3 h 6 min; 10% received thrombolysis; median door to needle time-60 min; 78.5% admitted to the stroke unit; 81.1% had a swallow assessment; in-patient mortality rate-10.5%; rates of institutionalisation-3.8%. The following areas were below the national average: overall door to imaging time-median 104 min; rate of thrombectomy-4%; 11.5% had mood screening; median length of stay- 12 days.
Using national and international audit data as an institutional benchmark provides a standard with which a service can be compared to highlight areas for improvement. We identified mood screening, swallow screening, thrombectomy rates, length of stay and time to neuroimaging as key areas for development in our centre. We are currently completing a process map to determine cause, effect, and solutions, and we will implement change using PDSA methodology as per SQUIRE 2.0 guidelines. The results of the re-audit cycle for 2020 will be available in 2021 to inform our progress. Ongoing quality improvement is essential for stroke care, which is a leading cause of death and disability in Ireland.
我们旨在评估爱尔兰一所教学医院的卒中护理，并与国家（2019 年爱尔兰国家卒中审计）和国际（第 6 届 SSNAP 年度报告；美国心脏协会，2013 年）实践进行基准比较，为质量改进策略提供信息。
通过 HIPE 数据库和机构卒中门户，确定所有 HIPE 出院诊断为脑梗死或脑出血的患者（2019 年 1 月 1 日至 12 月 31 日）。
共纳入 419 例患者（56.6%为男性，平均年龄 72 岁）。以下方面与爱尔兰国家卒中审计结果相当/更好：症状持续时间中位数为 3 小时 6 分钟；10%接受溶栓治疗；门到针时间中位数为 60 分钟；78.5%收入卒中单元；81.1%进行吞咽评估；住院死亡率为 10.5%；机构化率为 3.8%。以下方面低于国家平均水平：整体门到影像时间中位数为 104 分钟；取栓率为 4%；11.5%进行情绪筛查；中位住院时间为 12 天。
将国家和国际审计数据用作机构基准，可以提供一个服务比较标准，以突出需要改进的领域。我们确定情绪筛查、吞咽筛查、取栓率、住院时间和神经影像学时间是我们中心发展的关键领域。我们目前正在完成流程图，以确定原因、影响和解决方案，并将按照 SQUIRE 2.0 指南使用 PDCA 方法实施变更。2020 年的再审计周期结果将于 2021 年公布，以反映我们的进展。卒中护理需要持续质量改进，这是爱尔兰死亡和残疾的主要原因。
