Abstract
Background and aims: The aim of telestroke services is to improve the quality of stroke care provided to distant sites. AHA/ASA and ESO have issued recommendations for quality monitoring (QM) in telestroke. Our study analyzed data on QM practices among telestroke networks, thereby providing a real-world insight.
Methods: A previous study by our group on global telestroke coverage for acute stroke had identified 254 telestroke networks. A detailed survey was thereafter circulated to network leads. Reported QM parameters were then compared with the results from a systematic review (SR) on acute telestroke networks.
Results: Eighty-eight of 254 networks responded to the survey. The systematic review analyzed 92 studies describing 64 acute telestroke networks across 17 countries. QM was performed by 64 of 88 surveyed networks (72.7%) and was described in all networks identified in published literature. Across both data sources, thrombolysis rate was the most frequently reported performance indicator (93.7% in survey, 87% in SR). In contrast, other recommended indicators were reported less frequently. Recanalization rate, discharge NIHSS and in-hospital mortality were documented by 54.7% vs 35.9% (survey vs SR), 65.6% vs 1.6% and 78.1% vs 31.3% of networks. Other details of QM are mentioned in table 1.
Conclusions: Our study is the first real-world insight into the state of QM in telestroke both from peer-reviewed literature and self-reported data. The observed heterogeneity and low uptake of recommended quality indicators highlights a potential need for consensus on a standardized minimal QM dataset to facilitate feasible QM and facilitate comparison of outcomes across networks.