[Influence of acute stroke care organization on the implementation of clinical practice guidelines].
BACKGROUND
Patients who receive care in a dedicated stroke unit are more likely to survive and become independent. Specific guidelines describe evidence-based care practices. We examined the results of a French audit validation campaign to determine whether the presence of a stroke unit had an influence on the implementation of these recommendations.


METHODS
Eleven hospital centers volunteered for self-evaluation. Care delivered to patients in the emergency room and in the hospital unit (dedicated stroke unit or not) was assessed with the clinical audit method.


RESULTS
Compared with non-dedicated units, care delivered in stroke units was significantly more compliant with published recommendations. All aspects of acute stroke care were concerned: initial evaluation, acute phase treatment, screening for complications and their treatment, multidisciplinary team coordination, discharge preparation. Care delivered in dedicated stroke units was more reproducible, protocols were more widely used, acute phase risks were better prevented, and acute and postacute care was better coordinated between professionals. A second audit one year later showed increased quality of care in both dedicated and non-dedicated units, with more items improved in the latter.


CONCLUSIONS
Although statistical bias cannot be excluded, this study suggests that recommendations are applied better in dedicated stroke units. A second audit showed better compliance with recommendations, especially in non-dedicated units.
Service de neurologie, centre hospitalier Jacques-Coeur, 145, avenue François-Mitterrand, 18000 Bourges, France. ebodiguel@wanadoo.fr
E
E
Bodiguel
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R
Thiery
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G
Lairy
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F
Woimant
D000208:Acute Disease; D004636:Emergency Service, Hospital / Q000592:standards; D019317:Evidence-Based Medicine; D005602:France; D006785:Hospitals, University; D006801:Humans; D010347:Patient Care Planning; D017410:Practice Guidelines as Topic / Q000592:standards*; D020521:Stroke / Q000628:therapy*