What a pile of shit! You didn't even measure the most important quality indicator of all. 100% RECOVERY!
Measure recovery and results, NOT groin puncture time or increase in EVT rates. I'd fire everyone involved in this.
“What's measured, improves.” So said management legend and author Peter F. Drucker
Evolution of quality indicators in acute stroke during the RACECAT Trial: Impact in the general population
Abstract
Background:
Acute
ischemic stroke patients not referred directly to a comprehensive
stroke center (CSC) have reduced access to endovascular treatment (EVT).
The RACECAT trial is a population-based cluster-randomized trial,
designed to compare mothership and drip-and-ship strategies in acute
ischemic stroke patients outside the catchment area of a CSC.
Aims:
To analyze the evolution of performance indicators in the regions that participated in RACECAT.
Methods:
This
retrospective longitudinal observational study included all stroke
alerts evaluated by emergency medical services in Catalonia between
February 2016 and February 2020. Cases were classified geographically
according to the nearest SC: local SC (Local-SC) and CSC catchment
areas. We analyzed the evolution of EVT rates and relevant workflow
times in Local-SC versus CSC catchment areas over three study periods:
P1 (February 2016 to April 2017: before RACECAT initiation), P2 (May
2017 to September 2018), and P3 (October 2018 to February 2020).
Results:
We
included 20603 stroke alerts, 10,694 (51.9%) of which were activated
within Local-SC catchment areas. The proportion of patients receiving
EVT within Local-SC catchment areas increased (P1 vs. P3: 7.5% (95%
confidence interval (CI), 6.4–8.7) to 22.5% (95% CI, 20.8–24.4) p < 0.001).
Inequalities in the odds of receiving EVT were reduced for patients
from CSC versus Local-SC catchment areas (P1: odds ratio (OR) 3.9 (95%
CI, 3.2–5) vs. P3: OR 1.5 (95% CI, 1.3–1.7) In Local-SC, door-to-image
(P1: 24 (interquartile range (IQR) 15–36), P2: 24 (15–35), P3: 21
(13–32) min, p < 0.001) and door-to-needle times (P1: 42 (31–60), P2: 41 (29–58), P3: 35 (25–50) p < 0.001)
reduced. Time from Local-SC arrival to groin puncture also decreased
over time (P1: 188 [151–229], P2: 190 (157–233), P3: 168 (127–215) min, p < 0.001).
Conclusion:
An
increase in EVT rates in Local-SC regions with a significant decrease
in workflow times occurred during the period of the RACECAT trial.
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