Oral Presentation Smart Strokes Annual Scientific Meeting 2024

Pilot Phase of the Stroke Unit Certification Program: Characteristics and Performance of Acute Stroke Services Prior to Participation. (106907)

Melita Stirling 1 , Melita Stirling 1 , Catherine Burns 2 , Tara Purvis 2 , Leah Pett 1 , Timothy Kleinig 3 , Monique Kilkenny 2 , Dominique Cadilhac 2 4 , Kelvin Hill 1
  1. Stroke Foundation, Melbourne, Victoria, Australia
  2. Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
  3. Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
  4. Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia

Introduction 

Stroke unit (SU) certification programs can improve stroke care quality. The Australian Stroke Coalition piloted a voluntary program for SU certification in Australian hospitals in 2022/23. We aimed to compare acute stroke service baseline characteristics and clinical performance of the 11 certified sites to non-certified services, using data from the National Acute Stroke Services Audit 2023 (the Audit).  

 

Methods 

Organisational surveys and clinical data were analysed. Descriptive statistics and multilevel regression with service clustering were used to assess service characteristics and performance against Acute Stroke Standard Indicators. 

 

Results 

Certified sites comprised 3 comprehensive stroke centres, 5 primary stroke centres and 3 stroke-capable regional general hospitals (providing 613 records). An additional 96 non-certified services completed the organisational survey and 77 completed the clinical audit (4101 records). Similarities were evident in service location (state and metro/regional) and characteristics (e.g. stroke care coordinator certified 82%, non-certified 75%). SU care and timeliness of thrombolysis was significantly improved at certified services (SU: 85% vs 70%, OR 6.98 95% CI 1.2, 40.2; median door to needle time: 1:07 vs 1:24 OR p=0.035). Non-significant differences were evident in other indicators, including validated stroke screen in the emergency department (certified 85%, non-certified 73%, p=0.07) and use of thrombolysis (certified 13%, non-certified 10% p=0.09). 

 

Conclusion 

Stroke services who participated in the SU certification pilot program had similar characteristics to non-certified services. Certified services had higher SU access before certification.  Further analysis and experience is needed to understand whether improved care results from participation in the certification process in addition to predicting participation.  

 

Relevance to clinical practice 

Improving SU care is a national priority. Services with higher levels of SU access appear to have been early participants in the SU certification process. It is imperative all remaining services undertake certification as an important step to meet national targets.