Current Practices in Stroke Systems of Care: An International Survey of Progressive Stroke System Processes

Background and AimsGuidelines by the AHA/ASA recommend the development of stroke systems of care yet do not provide specifics as to how this should be done. As a first step in developing a regional stroke system of care in the "Stroke Belt" we sought to understand how high performing stroke systems across the world were organized in order to identify best practices and opportunities for meaningful system improvement. MethodsAn 81-question survey was developed to examine current practices in high-performing stroke systems. Twenty stroke centers worldwide were invited to participate. The survey encompassed all aspects of stroke systems of care from acute care and EMS practices to IT and discharge. Data analysis was conducted using REDCap internal analytic tools. ResultsNine of 20 invited centers (45%) completed the questionnaire. Responding centers reported annual averages (median) of 750 ischemic strokes (range 350-1444) and 125 (100-501) hemorrhagic strokes, 150 (60-440) IV alteplase administrations, and 55 (12-130) endovascular thrombectomy procedures. At all 9 systems, EMS providers are trained in identifying stroke and utilize prehosptial stroke scales. Six (66.7%) reported destination protocols based on stroke severity involving bypass to endovascular thrombectomy capable (EVT-C) centers. All centers report expedited referral hospital transfer processes for neurointervention. Five (55.6%) centers reported patients with confirmed large vessel occlusions bypass the emergency department and are transported directly to the neurointerventional suite. ConclusionsThis international survey reveals useful practice patterns and processes used by progressive stroke systems. This information will be integrated into our regional system of care quality improvement program.