Surprises with stroke

It has been a week of head scratchers for stroke, particularly in the in-hospital setting.

First, a study based on Canadian registry data found that patients who experience an in-hospital stroke are more likely to face delays in treatment than people whose acute stroke occurred in the community. The differences are striking: 4.5 hours vs. 1.2 hours for recognizing symptoms; almost half the proportion of in-hospital stroke patients undergoing brain imaging within two hours of that recognition; and an even smaller percentage getting thrombolysis treatment within 90 minutes of a diagnosis.

While among physicians, nurses and medical staff with the infrastructure for diagnosing and treating stroke perhaps only a floor or wing away, these patients had longer waits, with the potential for worse outcomes than counterparts in home and other settings. It may seem counterintuitive, but with many critical issues competing for attention in a hospital, it also is understandable. 

Registry data didn’t include reasons for delays, and the authors recommended creating a standardized approach for recognizing stroke and protocols for in-hospital stroke. The recommendations sounds like a good start.

Another study examined the role of EHRs in the quality of ischemic stroke care and outcomes. The researchers chose stroke because guidelines for stroke have evolved quickly and there is increasing use of quality measures in the field. And under the Health Information Technology for Economic and Clinical Health Act’s carrot-stick approach, many hospitals have incorporated health IT into their programs.

That doesn’t mean the technology is good or that they embraced it. The study found no association in adjusted analyses between EHR status and better quality of care or most outcomes. The one exception was a slightly better chance of a shorter length of stay after stroke in hospitals with EHRs.

The EHRs may not function in a way that is compatible with stroke care, or hospitals may not use the technology advantageously. It also is possible that EHRs facilitate care in other ways, such as helping hospitals track patients after discharge or in communications with primary care physicians or nursing homes, the authors proposed.  

These findings point to a common need in stroke care: tools that help providers identify priorities and then help them act on them. Right now they seem to be lacking.

Candace Stuart

Editor, Cardiovascular Business