Comparison of acute stroke care pathways-Aqualitative multicenter study in three referring hospitals of astroke network

Abstract

In stroke networks, hospitals that do not provide thrombectomy (referring hospitals) refer patients to specialized hospitals (receiving hospitals) for this specific intervention. In order to improve the access and management of thrombectomy, the focus of research needs to be not only on the receiving hospitals but also on the prior stroke care pathways in referring hospitals. The purpose of this study was to investigate the stroke care pathways in different referring hospitals as well as the advantages and disadvantages associated with these pathways. Aqualitative multicenter study was carried out in three referring hospitals of astroke network. Stroke care was assessed and analyzed by using non-participant observations and 15semi-structured interviews with employees in various health professions. The following aspects were reported as advantageous within the stroke care pathways: (1)astructured and personal prenotification of the patient by the emergency medical service (EMS) members; (2)amore efficiently organized teleneurology workflow; (3)the provision of the secondary referral to thrombectomy by the same EMS members of the primary referral and (4)the integration of external neurologists into in-house structures. The study provides insights into different stroke care pathways of three different referring hospitals of astroke network. The results can be used to derive potentials for improvement of other referring hospitals; however, this study is too small to provide reliable information about their potential effectiveness. Future studies should investigate whether implementation of these recommendations actually leads to improvements and under which conditions they are successful. To ensure patient-centeredness, the perspectives of patients and relatives should also be included.