title: [Why is reperfusion therapy delayed in stroke code patients? A qualitative analysis].
abstract: BACKGROUND
  Efficacy and safety of reperfusion therapy in acute ischaemic stroke is time-dependent and has a limited therapeutic window, which is, in fact, the main exclusion criterion. Initiatives to evaluate the quality of care are essential to design future interventions and ensure the shortest management times and application of such treatments.
  
  
  OBJECTIVE
  The aim of the study is to identify and classify potential causes of delay in the administration of reperfusion therapy in a tertiary hospital, a reference for the comprehensive treatment of acute ischaemic stroke.
  
  
  METHODS
  The project was developed in Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. A total of 337 patients with acute ischaemic stroke treated with reperfusion therapies were evaluated. For qualitative analysis, 2 working groups were formed: an advocacy group that designed and directed the entire project, and a multidisciplinary one, which served as a source of information and a mechanism for active involvement of all professionals in the stroke-care chain. Information was collected in 3 meetings and then, both the flowcharts and the cause-effect diagram were prepared.
  
  
  RESULTS
  Based on the above tools, potential causes of delay were identified and classified according to an operational criterion into unmodified structures, and modifiable ones with known evidence and hypothetical repercussions. Modifiable ones are noted for their importance in the design of future improvement interventions in stroke care. Some of them are: Variability in following established protocols, lack of procedures in some parts of the stroke-care chain, etc.
  
  
  CONCLUSIONS
  Knowledge of the current situation has just been the starting point, but it has been an essential requisite for the design and implementation of a quality improvement program to shorten in-hospital stroke code times.
authors.affiliation: Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España. Electronic address: abega_ct@hotmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Palazón-Cabanes
authors.affiliation: Unidad de Calidad Asistencial, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: J J
authors.initials: JJ
authors.lastname: López-Picazo-Ferrer
authors.affiliation: Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: A
authors.initials: A
authors.lastname: Morales-Ortiz
authors.affiliation: Unidad de Calidad Asistencial, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
authors.forename: N
authors.initials: N
authors.lastname: Tomás-García
mesh_terms: D006761:Hospitals; D006801:Humans; D058996:Quality Improvement; D015424:Reperfusion; D013030:Spain; D020521:Stroke / Q000628:therapy*; D013997:Time Factors
keywords: Acute stroke; Delay; Demora; Hospital; Ictus agudo; Tratamiento; Treatment