Quality improvement in acute stroke: The New York State Stroke Center Designation Project

T. I. Gropen, P. J. Gagliano, C. A. Blake, Ralph L Sacco, T. Kwiatkowski, N. J. Richmond, D. Leifer, R. Libman, S. Azhar, M. B. Daley

Research output: Contribution to journalArticle

110 Citations (Scopus)

Abstract

BACKGROUND: Many hospitals lack the infrastructure required to treat patients with acute stroke. The Brain Attack Coalition (BAC) published guidelines for the establishment of primary stroke centers. OBJECTIVE: To determine if stroke center designation and selective triage of acute stroke patients improve quality of care. METHODS: Baseline chart abstraction was performed on all stroke patients admitted to 32 hospitals serving Brooklyn and Queens, NY, from March to May 2002. Hospitals were invited to meet BAC guideline-based criteria. Adherence was verified by on-site visits. After designation, acute stroke patients were selectively triaged. Remeasurement data were collected from August to October 2003. RESULTS: The authors abstracted 1,598 charts at baseline and 1,442 charts at remeasurement. From baseline to remeasurement, median times decreased for door to physician contact (25 vs 15 minutes, p = 0.001), CT performance for potential tissue plasminogen activator (t-PA) candidates (68 vs 32 minutes, p < 0.001), and t-PA administration (109 vs 98 minutes (p = NS). IV t-PA utilization increased from 2.4 to 5.2% (p < 0.005), select t-PA protocol violations decreased from 11.1 to 7.9% (p = NS), and the stroke unit admission rate increased from 16 to 39% (p < 0.001). In stroke centers (n = 14) vs nondesignated hospitals (n = 18), there were shorter median times from door to physician contact (10 vs 25 minutes, p < 0.001), CT performance for potential t-PA candidates (31 vs 40 minutes, p = NS), and t-PA administration (95 vs 115 minutes, p < 0.05). Stroke centers, compared with nondesignated centers, admitted acute stroke patients to stroke units more often (55.9 vs 10.9%, p < 0.001). CONCLUSIONS: Stroke center designation and selective triage of acute stroke patients improved the quality of care, including access to timely thrombolytic therapy and stroke units.

Original languageEnglish
Pages (from-to)88-93
Number of pages6
JournalNeurology
Volume67
Issue number1
DOIs
StatePublished - Jul 1 2006
Externally publishedYes

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Quality Improvement
Stroke
Tissue Plasminogen Activator
Quality of Health Care
Triage
Guidelines
Physicians
Thrombolytic Therapy
Brain

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Gropen, T. I., Gagliano, P. J., Blake, C. A., Sacco, R. L., Kwiatkowski, T., Richmond, N. J., ... Daley, M. B. (2006). Quality improvement in acute stroke: The New York State Stroke Center Designation Project. Neurology, 67(1), 88-93. https://doi.org/10.1212/01.wnl.0000223622.13641.6d

Quality improvement in acute stroke : The New York State Stroke Center Designation Project. / Gropen, T. I.; Gagliano, P. J.; Blake, C. A.; Sacco, Ralph L; Kwiatkowski, T.; Richmond, N. J.; Leifer, D.; Libman, R.; Azhar, S.; Daley, M. B.

In: Neurology, Vol. 67, No. 1, 01.07.2006, p. 88-93.

Research output: Contribution to journalArticle

Gropen, TI, Gagliano, PJ, Blake, CA, Sacco, RL, Kwiatkowski, T, Richmond, NJ, Leifer, D, Libman, R, Azhar, S & Daley, MB 2006, 'Quality improvement in acute stroke: The New York State Stroke Center Designation Project', Neurology, vol. 67, no. 1, pp. 88-93. https://doi.org/10.1212/01.wnl.0000223622.13641.6d
Gropen, T. I. ; Gagliano, P. J. ; Blake, C. A. ; Sacco, Ralph L ; Kwiatkowski, T. ; Richmond, N. J. ; Leifer, D. ; Libman, R. ; Azhar, S. ; Daley, M. B. / Quality improvement in acute stroke : The New York State Stroke Center Designation Project. In: Neurology. 2006 ; Vol. 67, No. 1. pp. 88-93.
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N2 - BACKGROUND: Many hospitals lack the infrastructure required to treat patients with acute stroke. The Brain Attack Coalition (BAC) published guidelines for the establishment of primary stroke centers. OBJECTIVE: To determine if stroke center designation and selective triage of acute stroke patients improve quality of care. METHODS: Baseline chart abstraction was performed on all stroke patients admitted to 32 hospitals serving Brooklyn and Queens, NY, from March to May 2002. Hospitals were invited to meet BAC guideline-based criteria. Adherence was verified by on-site visits. After designation, acute stroke patients were selectively triaged. Remeasurement data were collected from August to October 2003. RESULTS: The authors abstracted 1,598 charts at baseline and 1,442 charts at remeasurement. From baseline to remeasurement, median times decreased for door to physician contact (25 vs 15 minutes, p = 0.001), CT performance for potential tissue plasminogen activator (t-PA) candidates (68 vs 32 minutes, p < 0.001), and t-PA administration (109 vs 98 minutes (p = NS). IV t-PA utilization increased from 2.4 to 5.2% (p < 0.005), select t-PA protocol violations decreased from 11.1 to 7.9% (p = NS), and the stroke unit admission rate increased from 16 to 39% (p < 0.001). In stroke centers (n = 14) vs nondesignated hospitals (n = 18), there were shorter median times from door to physician contact (10 vs 25 minutes, p < 0.001), CT performance for potential t-PA candidates (31 vs 40 minutes, p = NS), and t-PA administration (95 vs 115 minutes, p < 0.05). Stroke centers, compared with nondesignated centers, admitted acute stroke patients to stroke units more often (55.9 vs 10.9%, p < 0.001). CONCLUSIONS: Stroke center designation and selective triage of acute stroke patients improved the quality of care, including access to timely thrombolytic therapy and stroke units.

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