In-Hospital Versus Out-of-Hospital Stroke Onset Comparison of Process Metrics in a Community Primary Stroke Center

Felix E Chukwudelunzu; Bart Demaerschalk; Leonardo Fugoso; Emeka Amadi; Donn Dexter; Angela Gullicksrud; Clinton Hagen

doi:10.1016/j.mayocpiqo.2023.07.003

In-Hospital Versus Out-of-Hospital Stroke Onset Comparison of Process Metrics in a Community Primary Stroke Center

Mayo Clin Proc Innov Qual Outcomes. 2023 Sep 7;7(5):402-410. doi: 10.1016/j.mayocpiqo.2023.07.003. eCollection 2023 Oct.

Authors

Felix E Chukwudelunzu¹, Bart Demaerschalk², Leonardo Fugoso¹, Emeka Amadi³, Donn Dexter¹, Angela Gullicksrud¹, Clinton Hagen⁴

Affiliations

¹ Department of Neurology, Mayo Clinic Health System Eau Claire, WI.
² Department of Neurology, Mayo Clinic College of Medicine and Sciences, Phoenix, AZ.
³ Department of Medicine, Section of Hospital Medicine, Mayo Clinic Health System Eau Claire, WI.
⁴ Program for Hypoplastic Left Heart Syndrome, Mayo Clinic, Rochester, MN.

Abstract

Objective: To examine in-hospital stroke onset metrics and outcomes, quality of care, and mortality compared with out-of-hospital stroke in a single community-based primary stroke center.

Patients and methods: Medical records of in-hospital stroke onset were compared with out-of-hospital stroke onset alert data between January 1, 2013 and December 31, 2019. Time-sensitive stroke process metric data were collected for each incident stroke alert. The primary focus of interest was the time-sensitive stroke quality metrics. Secondary focus pertained to thrombolysis treatment or complications, and mortality. Descriptive and univariable statistical analyses were applied. Kruskal-Wallis and χ² tests were used to compare median values and categorical data between prespecified groups. The statistical significance was set at α=0.05.

Results: The out-of-hospital group reported a more favorable response to time-sensitive stroke process metrics than the in-hospital group, as measured by median stroke team response time (15.0 vs 26.0 minutes; P≤.0001) and median head computed tomography scan completion time (12.0 vs 41.0 minutes; P=.0001). There was no difference in the stroke alert time between the 2 groups (14.0 vs 8.0 minutes; P=.089). Longer hospital length of stay (4 vs 3 days; P=.004) and increased hospital mortality (19.3% vs 7.4%; P=.0032) were observed for the in-hospital group.

Conclusions: The key findings in this study were that time-sensitive stroke process metrics and stroke outcome measures were superior for the out-of-hospital groups compared with the in-hospital groups. Focusing on improving time-sensitive stroke process metrics may improve outcomes in the in-hospital stroke cohort.