AANN Comprehensive Review for Stroke Nursing, 2nd Edition, Ch. 8 Systems and Quality: Digital Version-Stroke Chapter 8

Stroke Chapter 8

Pdf Summary

Stroke care is most effective when delivered through a coordinated, evidence-based system spanning prevention, community education, emergency response, hospital treatment, secondary prevention, rehabilitation, and end-of-life care. Because these services can operate in silos, programs use clinical practice guidelines, protocols, order sets, workflows, and external certification to standardize care and improve outcomes.<br /><br />Acute stroke pathways coordinate EMS, emergency departments, stroke teams, imaging, treatment, and disposition. Prehospital recognition, rapid transport, and hospital notification help prepare teams and resources. Key targets include stroke-team assessment within 15 minutes, CT initiation within 25 minutes, interpretation within 45 minutes, and eligible treatment within 60 minutes of arrival. Stroke teams should be available 24/7 and use evidence-based protocols for ischemic and hemorrhagic stroke. Ongoing care includes complication prevention, monitoring, risk-factor management, education, and timely rehabilitation.<br /><br />Quality improvement uses systematic data collection and review. The Donabedian model examines care structure, processes, and outcomes; the Institute of Medicine domains emphasize safe, effective, patient-centered, timely, efficient, and equitable care. Common improvement tools include Plan-Do-Study-Act cycles, Six Sigma/LEAN, and root-cause analysis. Measures may track treatment times, guideline adherence, complications, functional outcomes, patient satisfaction, and transfers across the care continuum.<br /><br />Stroke-center certification levels include stroke-ready facilities, primary stroke centers, thrombectomy-capable centers, and comprehensive stroke centers. Requirements vary, but generally address 24/7 staffing and services, written protocols, imaging and treatment capacity, rehabilitation, education, organizational support, outcome monitoring, and continuous improvement. Higher-level centers provide advanced neurointerventional, neurosurgical, and neurocritical care capabilities. Certification supports organized care and is associated with improved treatment access and outcomes.

Keywords

stroke care

acute stroke pathway

clinical practice guidelines

emergency response

secondary prevention

rehabilitation

quality improvement

Donabedian model

stroke center certification

thrombectomy-capable center