Quality of Care and Outcomes for Patients With Stroke in the United States Admitted During the International Stroke Conference

So even though a lot of your senior staff are at the International Stroke conference the failures of getting stroke patients fully recovered continues. Failure no matter what, everything in stroke is a fucking failure and nobody at the conference will talk about those failures. 

Quality of Care and Outcomes for Patients With Stroke in the United States Admitted During the International Stroke Conference

Steven R. Messé

Michael T. Mullen

Margueritte Cox

Gregg C. Fonarow

Eric E. Smith

Jeffrey L. Saver

Mathew J. Reeves

Deepak L. Bhatt

Roland Matsouaka

Lee H. Schwamm

Originally published31 Oct 2018Journal of the American Heart Association. 2018;7:e009842

Abstract

Background

Patients presenting to hospitals during non–weekday hours experience worse outcomes, often attributed to reduced staffing. The American Heart Association International Stroke Conference (ISC) is well attended by stroke clinicians. We sought to determine whether patients with acute ischemic stroke (AIS) admitted during the ISC receive less guideline‐adherent care and experience worse outcomes.

Methods and Results

We performed a retrospective cohort study of US hospitals participating in Get With The Guidelines–Stroke and assessed use of intravenous tissue plasminogen activator, other quality measures, and outcomes for patients with AIS admitted during the ISC compared with those admitted the weeks before and after the conference. A total of 69 738 patients with AIS were included: mean age, 72 years; 52% women; 29% nonwhite. There was no difference between the average weekly number of AIS cases admitted during ISC weeks versus non‐ISC weeks (1984 versus 1997; P=0.95). Patient and hospital characteristics were similar between ISC and non‐ISC time periods. There were no significant differences(So the failure rate of recovery continued regardless of who is staffing the department?) in 14 quality metrics and 5 clinical outcomes between patients with AIS treated during the ISC versus non‐ISC weeks. Patients with AIS who presented within 2 hours of onset had no difference in the likelihood of receiving intravenous tissue plasminogen activator within 3 hours (adjusted odds ratio, 0.89; 95% confidence interval, 0.77–1.03; P=0.13) or the likelihood of receiving intravenous tissue plasminogen activator within 60 minutes of arrival (adjusted odds ratio, 0.92; 95% confidence interval, 0.83–1.02; P=0.13).

Conclusions

Patients with acute stroke admitted to Get With The Guidelines–Stroke hospitals during ISC received the same quality care and had similar outcomes as patients admitted at other times.(So the failure rate of recovery continued regardless of who is staffing the department?)

Clinical Perspective

What Is New?

• Clinical quality care metrics and outcomes for patients admitted with acute ischemic stroke do not change during the time of the International Stroke Conference.

What Are the Clinical Implications?

• These findings are reassuring(NO, they are extremely distressing because you are attributing failure to recover as OK) for sites that participate in the Get With The Guidelines–Stroke quality improvement program.
• It is unknown whether patients with stroke admitted to hospitals that do not participate in Get With The Guidelines are similarly unaffected by the International Stroke Conference.

Introduction

Multiple studies have reported that patients who present to a hospital during a weeknight or weekend receive suboptimal care and experience worse outcomes, possibly attributable to reduced staffing during these periods.¹ Similar challenges may exist when physicians attend large disease‐specific scientific meetings during which staffing may be reduced and clinicians who stay behind may have less expertise in caring for patients with the relevant disease. A prior study of high‐risk patients with heart failure and cardiac arrest who presented to teaching hospitals during the time of national cardiology meetings had lower 30‐day mortality, although patients with acute myocardial infarct were less likely to receive a percutaneous coronary intervention.⁴
It remains unclear how major scientific meetings affect the care of patients with acute ischemic stroke (AIS). The American Heart Association/American Stroke Association International Stroke Conference (ISC) is the largest conference of its kind in the world and attracts physicians, nurses, and coordinators focused on stroke care and research. Get With The Guidelines (GWTG)–Stroke is a voluntary national registry and quality improvement initiative that captures a substantial percentage of stroke admissions in the United States and provides a unique opportunity to assess the impact of this annual meeting on the care of patients with AIS. We hypothesized that patients with AIS admitted during the ISC would receive intravenous tissue plasminogen activator (tPA) at the same rate and that they would have similar overall quality‐of‐care and clinical outcomes as patients admitted at other times.