Development of a National Stroke Audit to Enhance Acute Stroke Care Quality in Ireland:Scoping Review & Delphi Consensus

BackgroundPopulation ageing, treatment advances, evolving models of care, and between-hospital heterogeneity in patient outcomes underscore the need for continual audit to ensure the delivery of high-quality, equitable, and evidence-based stroke care. This study aimed to develop a core minimum dataset for acute stroke care in Ireland, for integration into the Irish National Audit of Stroke (INAS), benchmarked against, and aligned with, international best practice. MethodsThis scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR). Medline Ovid, Embase, CINAHL EBSCOhost, and pertinent grey literature were searched from 2010 to identify national and continuous stroke audits. Titles, abstracts, and full texts were assessed for eligibility. Audit documentation was retrieved from identified eligible audits and stroke care data items were extracted, translated, and charted. Data charting enabled comparison of existing Irish audit items with frequently collected international items to identify commonalities and/or gaps in coverage. Acute stroke care items were then reviewed by key stakeholders in a three-round Delphi consultation. ResultsTwenty-one eligible international stroke audits and registries were identified, containing [~]4,500 audit items. Key stakeholders were consulted for their expert perspectives on the existing Irish (n=103), frequently collected international (n=97), and additional expert-suggested (n=22) acute items regarding their potential inclusion in INAS. Following consensus, a core minimum dataset comprising 86 acute care and 35 thrombectomy items was finalised. ConclusionsThe findings of this scoping review represent the "ideal" core outcomes dataset for acute stroke care in Ireland, derived from international benchmarking and stakeholder consultation. This dataset serves as the "gold standard" for monitoring acute stroke care in Ireland, aimed at enhancing patient outcomes, and supporting local and national quality improvement initiatives.