Quality of stroke care within a hospital: effects of a mobile stroke service.
OBJECTIVE
An Australian stroke services study (SCOPES) has developed a framework to compare different forms of acute stroke services, the gold standard being localised stroke units. We aimed to use this framework to assess changes in the quality of stroke care over time as a sequential audit process.


METHODS
A retrospective medical record audit comparing 100 sequential stroke admissions (July 2002 to June 2003) two years after institution of a mobile stroke service (MSS) with 100 historical controls (September 1998 to October 1999) at a 260-bed hospital in Melbourne. The MSS results were also compared with stroke units in SCOPES.


METHODS
Adherence to quality indicators and standard measures of outcome (complications, length of stay and discharge disability) after implementing the MSS.


RESULTS
Significant improvements were seen in prophylaxis for deep-vein thrombosis, incontinence management, premorbid function documentation, frequent neurological observations and early occupational therapy. The MSS demonstrated fewer severe complications (9% versus 24%; P = 0.004), reduced median length of stay (discharged patients: 12.0 days versus 18.5 days; P = 0.003) and more patients were independent at discharge (32% versus 9%; P < 0.001). Comparison with SCOPES stroke units showed our MSS could improve in incontinence management and appropriate use of antiplatelet therapy.


CONCLUSIONS
Institution of the MSS was associated with improvements in the quality of stroke care. This study demonstrates application of an audit procedure for quality improvement in hospital stroke management and the potential to improve stroke services in smaller centres.
van der Walt
Anneke
A
Department of Medicine, The Alfred Hospital, Prahran, VIC. annekedonovan@yahoo.com
Gilligan
Amanda K
AK
Cadilhac
Dominique A
DA
Brodtmann
Amy G
AG
Pearce
Dora C
DC
Donnan
Geoffrey A
GA
D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008485:Medical Audit; D008952:Mobile Health Units; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome