Abstract
Background: Acute ischemic stroke (AIS) clinical outcomes are time-dependent and are influenced by the organization and capability of the care delivery system. The focus of stroke care quality improvement has emphasized process and procedure. Integrating a systematic assessment of the structure and inter-dependencies of the stroke care team members has the potential to enhance the understanding of the overall function of the team and strengthen existing quality improvement efforts. Objective: Describe a multi-modal quality improvement approach consisting of process/clinical outcome measures, workflow analysis and personnel structure mapping of acute stroke care teams. Method: Key site-specific hospital characteristics, including the variability of stroke treatment processes of individual teams, were identified. A critical path analysis was created based on a standard acute stroke care process model. Stroke care team structures and inter-dependencies were mapped based on the responses to a short survey and the responses were analyzed using open source network analytic software (Gephi). Analysis results were interpreted in context of the characteristics of the hospital units. Results: The care team personnel structures were overlayed on the stroke care process pathways to create a final synthesis of the process and team structure ( (Example in figure below). Critical path analyses combined with previously unidentified opportunities to strengthen the individual team member interactions were linked to process/clinical outcomes. Opportunities for site-specific improvement in both process and personnel organization and communication were identified. Case studies will be presented. Conclusion: A clinical microsystems analytic approach that includes formal site-specific representations of the care team structure is feasible and provides a valuable addition to process analysis for quality improvement programs.
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