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Table 2 The process indicators set

From: A cluster randomized trial to assess the impact of clinical pathways for patients with stroke: rationale and design of the Clinical Pathways for Effective and Appropriate Care Study [NCT00673491]

Indicator

Measure

Criterion met/expected change

Source, Year

Information, advice and support from the multidisciplinary team given to the patients (and with their consent, to the carers)

(%)

Given to all the patients/relatives/care givers

SIGN 64, 2002

Use of referral protocols (to neurovascular clinics and admission to stroke unit)

(%)

Given to all the patients

NHS QIS (CSBS-PPI 2002) Clinical Standards, 2004; CHD/Stroke Task Force, 2001; SPREAD, 2005

Use of clinical protocols (at least 5 of the following)

(%)

Given to all the patients

CHD/Stroke Task Force, 2001; CSBS 2002; Antiplatelet Trialists' Collaboration, 1994; SIGN 13, 1997; European Atrial Fibrillation Trial, 1993; Hebert PR, 1997; SIGN 14, 1997; Antithrombotic Trialists' Collaboration, 1998

- Stroke treatment/management protocols

   

- Antiplatelet/anticoagulant protocol

   

- Diabetes treatment protocol

   

- Atrial fibrillation therapy protocol

   

- Blood pressure lowering protocol

   

- Cholesterol lowering protocol

   

- Suspected carotid stenosis protocol

   

- Smoking cessation protocol

   

Use of (local) admission to social services protocols

(%)

Given to all patients

Report to the Dept. of Health, 2000

Use of CT/MRI brain scan within 48 hours from admission

(%)

80%

SIGN 14, 1997; Wardlaw JM, 2003

Aspirin treatment within 48 hours from admission

(%)

Given to all patients

Gubitz G (Cochrane 2003)

Swallow screen test on day of admission

(%)

Given to all patients

SIGN 20, 1997

Blood pressure assessment

(%)

Given to all patients

Progress, 2001; NHS QIS (CSBS 2002); Clinical Standards, 2004

ECG/ECD within 24 hours from admission

(%)

Given to all patients

SIGN 13, 1997

Continuous monitoring within 48 hours from admission (see parameters below)

(%)

Differences in rates

SIGN 13, 1997; New Zealand Guidelines Group, 2003; Canadian Stroke Network and the Heart and Stroke Foundation of Canada, 2006

- Blood pressure

   

- Glycaemia

   

- Electrolitemia

   

- Breath

   

Before discharge total assessment (see parameters below)

(%)

Given to all patients

MRC/BHF Heart Protection Study, 2002, 2003; SIGN 24, 1998

- Tobacco smoke

   

- Lipemia

   

- Glycaemia

   

Use of discharge plan (and communication)

(%)

Given to all the patients/relatives/care givers

SIGN 24, 1998

Use of SIGN guidelines-based discharge plan

(%)

 

SIGN 24, 1998

Use of discharge summary and information (information pack)

(%)

 

RCPE, Consensus Panel, Nov 2000; SIGN 65, 2003