Quality Management in Acute Stroke Care: How to Evaluate and Improve the Preclinical/Clinical Interface in Stroke

Introduction: The time that passes before a patient arrives at the stroke unit shall be kept at a minimum by improving the preclinical/clinical interface for the acute treatment of strokes. Informing the clinic at an early point makes it possible to improve internal processes in the hospital. Suggestions regarding the measurement and evaluation of processes at the interface and their improvement based on these results are to be developed. Method: Experiences from the Stroke Angel project serve to analyse the preclinical and clinical processes of stroke treatment under consideration of aspects of quality management and to give definitions for measuring points. Based on these results, recommendations are given for the integration of preclinical processes into a quality management concept for stroke units, with the target of achieving constant evaluation and improvement of the preclinical/clinical interface. Results: Evaluation criteria and key figures for the preclinical/clinical interface have been determined. They can be divided into the knowledge of the clinical picture of apoplexy, process, and outcome criteria. Process criteria are mainly the preclinically and clinically acquired times between the onset of symptoms and the performance of a CT or the start of lysis therapy. Outcome criteria are related to the outcome of the disease measured by morbidity (NIHSS), mortality rate and modified Rankin scale (mRS) after 3 months. Conclusion: Precise collection and evaluation of data concerning the preclinical and intraclinical process times and outcome parameters lead to the possibility of evaluation and improvement of the treatment of apoplexy in Germany. These processes and analyses should be integrated into the quality management of a stroke unit and the rescue services.