Feedback System Speeds Up Stroke Treatment

TOPLINE:

Performance feedback reduces the time to endovascular thrombectomy in patients with ischemic stroke, according to a Dutch study.

METHODOLOGY:

• The researchers conducted a stepped-wedge cluster randomized PERFEQTOS trial in the Netherlands, which included 4747 consecutive adult patients with ischemic stroke who underwent endovascular thrombectomy between January 2020 and June 2022.
• Hospitals started with usual care and were randomized in clusters to transition to the intervention every 6 months.
• Performance feedback via an online dashboard was provided every quarter to the hospitals, which enabled quality improvement teams to develop, implement, and evaluate targeted action plans on the basis of benchmarked indicators of care.
• The primary outcome measure was the time from door to groin puncture. Secondary outcomes were door-to-needle time, neurological deficits (assessed using the National Institutes of Health Stroke Scale [NIHSS] score at 2 days), angiographic reperfusion (evaluated using the expanded Treatment in Cerebral Infarction [eTICI] score), and functional outcomes (measured using the modified Rankin Scale [mRS] score at 3 months).

TAKEAWAY:

• The intervention reduced the median door-to-groin puncture time from 52 to 47 minutes (adjusted absolute difference, −4.8 minutes)
• Door-to-needle time was also reduced from 27 to 24 minutes.
• The NIHSS score at 24 hours, the median eTICI score after endovascular thrombectomy, and the median mRS score at 3 months were not significantly different between the groups.

IN PRACTICE:

“Performance feedback provided through a dashboard to local quality improvement teams reduces time to EVT [endovascular thrombectomy] for patients with ischemic stroke,” the authors wrote. Therefore, they recommend “performance feedback to be implemented in daily clinical routine, as it can improve quality of care for patients with ischemic stroke.”

SOURCE:

The study was led by Daniel Hansen, MD, Erasmus MC University Medical Center, Rotterdam, the Netherlands. It was published online on December 16, 2024, in JAMA Neurology.

LIMITATIONS:

Limitations included selection bias, missing data, the potential impact of COVID-19 protective measures on acute stroke care workflows, and baseline variations in hospital performance.

DISCLOSURES:

This study was funded by the Smarter Choices for Better Health initiative at Erasmus University Rotterdam in the Netherlands. One author chaired the Dutch Acute Stroke Audit from 2015 until 2023. Three authors reported institutional funding and consulting fees from sources unrelated to this work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.