Development of a national stroke audit in Ireland: scoping review protocol

Abstract

Introduction Recent advances in stroke management and care have resulted in improved survival and outcomes. However, providing equitable access to acute care, rehabilitation and longer-term stroke care is challenging. Recent Irish evidence indicates variation in stroke outcomes across hospitals, and a need for continuous audit of stroke care to support quality improvement. The aim of this project is to develop a core minimum dataset for use in the new Irish National Audit of Stroke (INAS), which aims to improve the standard of stroke care in Ireland. This paper outlines the protocol for conducting a scoping review of international practice and guidelines in auditing acute and non-acute stroke care. Objective Identify data items that are currently collected by stroke audits internationally, and identify audit guidelines that exist for recommending inclusion of content in stroke audit datasets. Methods and analysis This scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISMA-ScR). We will search the following databases: Medline Ovid; Embase; CINAHL EBSCOHost. Grey literature will also be searched for relevant materials, as will relevant websites. Study selection and review will be carried out independently by two researchers, with discrepancies resolved by a third. Data charting and synthesis will involve sub-dividing relevant sources of evidence, and synthesising data into three categories: i) acute stroke care; ii) non-acute stroke care; and iii) audit data collection procedures and resourcing. Data will be charted using a standardised form specific to each category. Consultation with knowledge users will be conducted at all stages of the scoping review. Discussion This scoping review will contribute to a larger project aimed at developing an internationally benchmarked stroke audit tool that will be used prospectively to collect data on all stroke admissions in Ireland, encompassing both acute and non-acute data items.

Impact of Frailty on Healthcare Outcomes after Cardioembolic Ischaemic Stroke Due to Atrial Fibrillation

“…This said, frailty is only recently being widely recognized as an accurate risk stratification approach to tailor appropriate management to patients with stroke, irrespective of age [ 56 ], and this is first study to examine its impact on stroke due to AF; the passage of time is not likely to alter the importance or relevance of these findings. Although small, it has the advantage of having a complete case ascertainment, given that stroke registry data are complete, as mandated nationally by Ireland’s National Clinical Programme for Stroke, which oversees the collection of stroke data in Ireland since the National Stroke Register was developed here in 2013 [ 57 ]. Another limitation is that only a single measure of frailty was used, which was based on information available in the chart rather than on a detailed comprehensive geriatric assessment (CGA), meaning that patients may have been misclassified or would have been classified differently based on other definitions of frailty, e.g., using the frailty phenotype.…”

Audit as a Tool for Improving the Quality of Stroke Care: A Review

“…Future studies should focus on applying standardized audit protocols to advance improvements in stroke care and allow for systematic comparisons between studies [38]. In order to improve clinical practice, a number of references may provide appropriate learning sessions and educational material regarding the following: the theory and practice of improvement [14,17,22]; meetings to improve adherence to guidelines [23,39]; case reviews conducted by researchers trained in the National Stroke Audit methodology [15]; regular conferences on quality measures and discussions of aspects that need to be improved [17]; and systems capable of quickly and regularly giving feedback [18].…”

Changes in anticoagulation practice in subjects admitted with stroke associated with atrial fibrillation, following introduction of direct oral anticoagulants over 2013–2021

“…We feel that the data from the earlier years are representative as it is consistent with the largest population study performed in the country, the NDPSS 4 that was completed just before the inception of the audit. Furthermore, the data submitted by the relevant stroke screens is validated against routinely collected activity and coding data from the hospitals often using a reconciliation process to confirm it and the data are collected predominantly by Clinical Nurse Specialists working in International Journal of Stroke, 19 (3) Stroke services. However, the number of hospitals evaluated, although admitting >90% of hospitalized strokes in the country, were comparatively small for statistical purposes; thus, only strong correlations were found to be significant at conventional levels and type I error is a risk.…”

“…International Journal of Stroke, 19 (3) subjects anticoagulated pre-stroke. We have also noticed a reduction in the proportion of strokes that are AF associated.…”

“…1,2 The Irish National Stroke Register, later incorporated into the National Office of Clinical Audit as the Irish National Audit of Stroke (INAS), was established in 2012 to collect data as to the performance of Irish Stroke Services and to identify areas of weakness in inpatient stroke care in Irish Hospitals. 3 The original INAS data set was developed taking regard of the then recently published North Dublin Population Stroke Study (NDPSS). 4 This found a 31.3% incidence of AF-associated stroke and 21.2% incidence of warfarin-associated intracerebral hemorrhage (IH) in the cohort.…”