Accreditation in stroke units of 6 European regions : One name different realities

481Background: ESO guidelines aim to promote standardised care of high quality in Europe but the organisation of acute care in stroke units (SU) largely differs between countries. This study aimed to scrutinize the accreditation or certification procedures of SU in 6 countries/regions: Scotland, Sweden, The Netherlands, France, Germany and the “London Stroke Services” (LSS). Methods: the information was collected with standardised questionnaires (25 pages) sent by mail to 12 experts from the 6 countries/regions. The research team analyzed the answers and clarified further issues by interviews. Results: an official mandatory accreditation procedure (organized and paid by governmental agencies) exists in Scotland, in LSS and in France. In Germany this procedure exists (private organizations) but is not mandatory. The accreditation process always implies at least site-visits and patient data review. Accreditation is renewed on a 1-, 3-, or 5-year basis. Some countries differentiate between types of SU (e.g. primary, comprehensive SU). The study further listed the criteria that SU must fulfil and the indicators measured for their accreditation (structure, process and outcome). Few of them refer to outcomes e.g. mortality, complications and recurrence. Incentives to encourage better quality differ between countries: public reporting of the results of the accreditation procedure, support to poor performers, benchmarking between hospitals, financial consequences. Conclusion: this exhaustive analysis gives an overview of the accreditation procedures in selected European countries. Care of high quality relies on a common evidence base but the quality assurance procedures, the indicators used as well as the consequences of the measurement largely differ between the countries. The question is to know if these various accreditation procedures result in differences in patients' outcomes