22. European Stroke Conference 363 Management and economics Quality indicators for stroke units: a combination of evidence and experts consensus R.O. Saka1, Y. Sun2, D. Michiels3, V. Thijs4, D. Hemelsoet5, M. Eyssen6, D. Paulus7 Deloitte, Diegem, BELGIUM1, Deloitte, Diegem, BELGIUM2, University Hospital Leuven, Leu-ven, BELGIUM3, University Hospital Leuven, Leuven, BELGIUM4, University Hospital Ghent, Ghent, BELGIUM5, Belgian Health Care Knowledge Centre, Brussels, BELGIUM6, Belgian Health Care Knowledge Centre, Brussels, BELGIUM7 Background The provision of care in stroke units (SU) improves stroke outcomes significantly. The European Stroke Organization set up a working group for accreditation in stroke care but in Belgium there are today no national quality criteria applied to SU. The aim of the present study was to define a set of quality indicators (QI) for SUs in Belgium. Methods Generic and disease-specific QIs databases and QIs used in other countries were searched and an ex-haustive list of stroke QIs was prepared. All QIs were grouped according to their characteristics and by their occurrence in the flow of care. QIs with a similar content but with different definitions were grouped into a single QI. The level of evidence to support each QI was summarized using the Scot-tish Intercollegiate Guidelines Network methodology. The process was validated by a first group of stroke experts. Seven stroke experts further rated the QIs on a scale from 1 (strongly disagree) to 9. They were asked to take 6 dimensions into account: relevance, validity, reliability, specificity, feasi-bility, potential for improvement. Results This process first identified 98 indicators and the final list included 48 QIs. A large amount of evi-dence were identified concerning process QIs (N=28) but less so for structure (N=15) and outcome QIs (N=5). Structure QIs included multidisciplinary stroke team and 24 hour brain imaging, train-ing of medical staff, availability of vascular imaging and of diagnostic methods, documentation and risk assessment in the medical records. Process QIs were classified as hyper-acute phase, early acute management, inpatient care, discharge care. The outcome QIs were mortality, improvement on speech and language, level of dependency, quality of life, and hospital-acquired pneumonia. Conclusion This study provided an exhaustive list of QIs for SU as well as their level of evidence. The findings are now further used by authorities and specialists to set up an accreditation system in Belgium. 478 © 2013 S. Karger AG, Basel Scientific Programme 364 Management and economics The importance of accurate examination of stroke patients in prehospital emergency care J. Betlehem1, V. Simon2, K. Deutsch3, J. Marton4, E. Pek5, B. Radnai6, A. Olah7 University of Pecs, Faculty of Health Sciences, Institute of Nursing and Patient Care, Pecs, HUNGARY1, Hungarian National Ambulance Service, Kormend, HUNGARY2, University of Pecs, Faculty of Health Sciences, Institute of Nursing and Patient Care, Pecs, HUNGARY3, University of Pecs, Faculty of Health Sciences, Institute of Nursing and Patient Care, Pecs, HUNGARY4, Univer-sity of Pecs, Faculty of Health Sciences, Institute of Nursing and Patient Care, Pecs, HUNGARY5, University of Pecs, Faculty of Health Sciences, Institute of Nursing and Patient Care, Pecs, HUN-GARY6, University of Pecs, Faculty of Health Sciences, Institute of Nursing and Patient Care, Pecs, HUNGARY7 Background: The suspect of acute stroke event is a common cause of calling ambulance in Euro-pean countries and in US. The symptoms reported to the dispatch centre might be various and it is always difficult to sort out the salient signs of an acute cerebral ischemia. According to the literature the initial diagnosis of stroke might be false (3-14%). Our aim was to assess the implementation of stroke protocol in emergency care, to identify failures in the care and to give recommendations for the practice. Methods: A retrospective patient’s record review was conducted in a Hungarian county (Vas) among patients diagnosed with stroke or suspected stroke in the ambulance care and trans-ported to the county teaching hospital (Szombathely). Both prehospital and hospital data were col-lected in 2009 (N=576). SPSS 15.0 was used for statistical analyses. Beside descriptive statistics, Chi-square, T-test and ANOVA were used. Results: The patient’s mean age was 69,6 years (min: 20, max: 96). In the given period the initial diagnosis of stroke or suspected stroke was verified in the hospital in 389 cases (65,38%). This ratio is less than those indicated in the international litera-ture. The most cases are reported among patients over 59 years (77,26%). As several studies report about female dominance in this study the gender distribution did not appear a significant factor (male:46,65%; female:53,35%). Cincinnati Prehospital Stroke Scale (CPSS) as specific checklist was documented completely in 111 cases (28,53%) only. Using CPSS correlated significantly with the accuracy of definitive diagnosis (p=0,03). At least one symptom of CPSS was documented in 326 cases (83,8%). The presence of at least one positive symptom of CPSS secured a certain final diagnosis (p=0,001). Conclusions: Applying all possible diagnostic procedures on the spot may lead to a more appropriate final diagnosis. In accordance with the literature, using CPSS in prehospital care predicts a more precise definitive diagnosis in stroke. Assessing at least only one CPSS symp-tom can already be beneficial for diagnosing stroke. In the refreshing courses the correct implemen-tation of guidelines should be explained.
Karger_ESC London_2013
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