Stroke Pathway impact on healthcare processes and outcomes: a retrospective observational study

The Stroke Pathway performance assessment is a key quality improvement element in healthcare. The aim of this study was to carry out a retrospective assessment of the Stroke Pathway in a first level Stroke Unit in Northern Italy and the possible impact of the COVID-19 pandemic. Methods: A retrospective observational study was carried out analysing data from 1/01/2010 to 31/12/2020. Data considered were: case volume and characteristics of patients undergoing intravenous thrombolysis, baseline modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) scores, Onset-to-Door (OTD), Door-To-Imaging (DTI) and DoorTo-Needle (DTN) Times, mRS score 3 months after the ischemic event onset (3m-mRS) and NIHSS score 24hours after the ischemic event onset (24h-NIHSS). The study also compared the pre-COVID-19 pandemic period (MarchDecember 2019) with the one following it (March-December 2020). Results: During the considered 10 years range, 418 patients underwent pharmacological thrombolysis. Treatment was extended to older patients (mean age from 66.3 to 75.51 years; p = 0.006) and with a higher baseline disability level (from 0.22 to 1.22; p = 0.000). A statistically significant reduction was found for DTN (from 90 to 61minutes average value; p = 0.000), so that in 2019 more than 50% and in 2020 more than 60% of patients were treated within 60minutes (golden hour). Comparing preand COVID-19 pandemic periods, the number of patients remained almost unchanged, but with a significantly higher baseline disability (mRS=1.18 vs 0.72, p = 0.048). The OTD increased from 88.13 to 118.48minutes, although without a statistically significant difference (p = 0.197). Conclusions: The study highlighted the Stroke Pathway positive impact, even during the COVID-19 pandemic, both on healthcare processes and patients’ outcomes. Nevertheless, both of them could be further improved through specific changes of the Pathway hospital phase and health communication actions. Key messages:  Stroke Pathway hospital phase (DTN score) could be improved by starting thrombolysis in the diagnostic imaging department to further align with the international guidelines standards.  Communication actions should be promoted to improve the Stroke Pathway pre-hospital phase (OTD score) providing the public with essential information to timely recognize stroke signs and symptoms.