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Incorporating Quality Improvement Projects Into Stroke Care and Research

In all areas of medicine including in stroke, we strive towards continuously improving work methods and the quality of care that is delivered to our patients. Following this principle, quality improvement (QI) projects have become increasingly important. QI can be defined as the design, development, and evaluation of complex interventions aimed at the redesign of health care systems to produce improved process control measures and outcomes.1 Quality of care may refer to safety, effectiveness, patient centeredness, efficiency, equity of care, or timeliness. QI studies are a specific type of research with a particular methodology. They aim to improve performance and consequentially the quality of care. QI draws its evidence from many different disciplines including research on manufacturing and air traffic control as well as evidencebased medicine. Scientific societies like the American Heart Association and American Stroke association produce guideline recommendations for the treatment of patients with stroke/transient ischemic attack, taking into account scientific evidence. These establish what is the best medical care for stroke/transient ischemic attack patients at a given moment. One way how QI studies can be used is to operationalize guideline recommendations for use in clinical practice. They may be performed to evaluate and to modulate the gap between evidence-based medicine and clinical practice. Evidence shows that time to treatment is a key point to improve the outcome of patients with stroke submitted to revascularization procedures. A QI study could be performed in a given stroke center to evaluate the current door-to-needle time and to define and test an intervention to improve these time points. We aim to describe what QI studies are, to provide a general outline of their design and implementation steps, describe what are quality indicators and to provide examples of their application in the stroke field.