title: Feasibility of certified quality management in a comprehensive stroke care network using telemedicine: STENO project.
abstract: BACKGROUND
  Stroke care networks with and without telemedicine have been established in several countries over the last decade to provide specialized stroke expertise to patients in rural areas. Acute consultation is a first step in the management of stroke, but not the only one. Methods of standardization of care and treatment are much needed. So far, quality management systems have only been used for single stroke units. To the best of our knowledge, we are the first stroke network worldwide to aim for certification of a network-wide quality management system.
  
  
  METHODS
  The Stroke Network Using Telemedicine in Northern Bavaria (STENO), currently with 20 associated medical institutions, is one of the world's largest stroke networks, caring for over 5000 stroke patients each year. In 2010, we initiated the implementation of a network-wide 'total' quality management system according to ISO standard 9001:2008 in cooperation with the German Stroke Society and a third-party certification organization (LGA InterCert).
  
  
  RESULTS
  Certification according to ISO 9001:2008 was awarded in March 2011 and maintained over a complete certification cycle of 3 years without major deviation from the norm in three external third-party audits. Thrombolysis rate significantly increased from 8·2% (2009) to 12·8% (2012).
  
  
  CONCLUSIONS
  Certified quality management within a large stroke network using telemedicine is possible and might improve stroke care procedures and thrombolysis rates. Outcome studies comparing conventional stroke care and telestroke care are inevitable.
authors.affiliation: Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany; Department of Neurology, Klinikum Neumarkt, Neumarkt, Germany.
authors.forename: René
authors.initials: R
authors.lastname: Handschu
authors.forename: Mateusz
authors.initials: M
authors.lastname: Scibor
authors.forename: Angela
authors.initials: A
authors.lastname: Wacker
authors.forename: David R
authors.initials: DR
authors.lastname: Stark
authors.forename: Martin
authors.initials: M
authors.lastname: Köhrmann
authors.forename: Frank
authors.initials: F
authors.lastname: Erbguth
authors.forename: Patrick
authors.initials: P
authors.lastname: Oschmann
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwab
authors.forename: Lars
authors.initials: L
authors.lastname: Marquardt
mesh_terms: D000368:Aged; D003195:Computer Communication Networks; D004185:Disability Evaluation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D020521:Stroke / Q000628:therapy*; D017216:Telemedicine / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
keywords: certification; quality management; stroke; stroke unit; telemedicine