Vol 58, No 1 (2024)
Research Paper
Published online: 2023-12-01

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External quality monitoring facilitates improvement in already well-performing stroke units: insights from RES-Q Poland

Michał Karliński1, Adam Kobayashi2, Maciej Niewada3, Waldemar Fryze4, Agata Tomczak5, Waldemar Brola6, Konrad Rejdak7, Piotr Luchowski7, Bożena Adamkiewicz8, Małgorzata Wiszniewska9, Urszula Włodarczyk9, Radosław Kaźmierski10, Pawel Kram11, Halina Bartosik-Psujek12, Rafał Kaczorowski12, Piotr Sobolewski13, Małgorzata Fudala14, Agata Gałązka15, Marcin Rogoziewicz16, Anna Rogoziewicz16, Halina Sienkiewicz-Jarosz17, Ewelina Cybulska17, Natalia Pożarowszczyk1, Jacek Staszewski18, Aleksander Dębiec18, Ewa Horoch-Łyszczarek19, Alicja Mączkowiak20, Anna Czlonkowska1
Pubmed: 38037889
Neurol Neurochir Pol 2024;58(1):75-83.


Introduction. The Registry of Stroke Care Quality (RES-Q) is used in Poland for quality monitoring by numerous hospitals participating in the Angels Initiative. Our aim was to assess the degree of improvement in highly stroke-oriented centres that report cases to the RES-Q each year.

Material and methods. This retrospective analysis included Polish stroke units that from January 2017 to December 2020 contributed to the RES-Q at least 25 patients annually.

Results. Seventeen out of 180 Polish stroke units reported patients each year (2017, n = 1,691; 2018, n = 2,986; 2019, n = 3,750; 2020, n = 3,975). The percentage of ischaemic stroke patients treated with alteplase remained stable (26%, 29%, 30% and 28%, respectively). The door-to-needle time progressively decreased, from a median 49 minutes to 32 minutes. The percentage of patients treated ≤ 60 minutes and ≤ 45 minutes significantly increased (from 68% to 86% and from 43% to 70%, respectively), with no change observed between 2019 and 2020. Despite a general improvement in dysphagia screening (81%, 91%, 98% and 99%), screening performed within the first 24h from admission became less frequent (78%, 76%, 69% and 65%). In-hospital mortality significantly increased (11%, 11%, 13% and 15%), while the proportion of patients discharged home remained stable.

Conclusions. Quality-oriented projects facilitate the improvement of stroke care, even in centres demonstrating good baseline performance. Polish stroke units that consistently reported cases to the RES-Q demonstrated improvement in terms of door-to- -needle time and dysphagia screening. However, there is still a need to shorten the time to dysphagia screening, and carefully monitor stroke unit mortality following the COVID-19 pandemic.

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Neurologia i Neurochirurgia Polska