Background and Purpose: Rapid access to acute stroke treatment improves clinical outcomes
in patients with ischemic stroke. We aimed to shorten the time to admission and to
acute stroke treatment for patients with acute stroke in the Hamburg metropolitan
area by collaborative multilevel measures involving all hospitals with stroke units,
the Emergency Medical Services (EMS), and health-care authorities. Methods: In 2007,
an area-wide stroke care quality project was initiated. The project included mandatory
admission of all stroke patients in Hamburg exclusively to hospitals with stroke units,
harmonized acute treatment algorithms among all hospitals, repeated training of the
EMS staff, a multimedia educational campaign, and a mandatory stroke care quality
monitoring system based on structured data assessment and quality indicators for procedural
measures. We analyzed data of all patients with acute stroke who received inhospital
treatment in the city of Hamburg during the evaluation period from the quality assurance
database data and evaluated trends of key quality indicators over time. Results: From
2007 to 2016, a total of 83,395 patients with acute stroke were registered. During
this period, the proportion of patients admitted within <= 3 h from symptom onset
increased over time from 27.8% in 2007 to 35.2% in 2016 (p < 0.001). The proportion
of patients who received rapid thrombolysis (within <= 30 min after admission) increased
from 7.7 to 54.1% (p < 0.001). Conclusions: Collaborative stroke care quality projects
are suitable and effective to improve acute stroke care.
