Quality indicators for stroke units : A combination of evidence and experts consensus

478Background The provision of care in stroke units (SU) improves stroke outcomes significantly. The European Stroke Organization set up a working group for accreditation in stroke care but in Belgium there are today no national quality criteria applied to SU. The aim of the present study was to define a set of quality indicators (QI) for SUs in Belgium. Methods Generic and disease-specific QIs databases and QIs used in other countries were searched and an exhaustive list of stroke QIs was prepared. All QIs were grouped according to their characteristics and by their occurrence in the flow of care. QIs with a similar content but with different definitions were grouped into a single QI. The level of evidence to support each QI was summarized using the Scottish Intercollegiate Guidelines Network methodology. The process was validated by a first group of stroke experts. Seven stroke experts further rated the QIs on a scale from 1 (strongly disagree) to 9. They were asked to take 6 dimensions into account: relevance, validity, reliability, specificity, feasibility, potential for improvement. Results This process first identified 98 indicators and the final list included 48 QIs. A large amount of evidence were identified concerning process QIs (N=28) but less so for structure (N=15) and outcome QIs (N=5). Structure QIs included multidisciplinary stroke team and 24 hour brain imaging, training of medical staff, availability of vascular imaging and of diagnostic methods, documentation and risk assessment in the medical records. Process QIs were classified as hyper-acute phase, early acute management, inpatient care, discharge care. The outcome QIs were mortality, improvement on speech and language, level of dependency, quality of life, and hospital-acquired pneumonia. Conclusion This study provided an exhaustive list of QIs for SU as well as their level of evidence. The findings are now further used by authorities and specialists to set up an accreditation system in Belgium