Oral Presentation Smart Strokes Annual Scientific Meeting 2025

Hospital quality improvement activities and improvement in quality of care: Insights from the Australian Stroke Clinical Registry (127729)

Dominique A Cadilhac 1 2 , Julie L Morrison 1 , Mulugeta M Birhanu 2 , Lachlan L Dalli 2 , Kate Paice 1 , Helen Carter 1 , Bruce Campbell 3 , Monique Kilkenny 2 , Rohan Grimley 4 , Natasha A Lannin 5 6 , Sandy Middleton 7 8 , Helen Dewey 9
  1. The Florey Institute of Neuroscience and Mental Health, HEIDELBERG, VICTORIA, Australia
  2. Stroke and Ageing Research, School of Clinical Sciences , Monash University , Clayton, Victoria, Australia
  3. Royal Melbourne Hospital , Melbourne , Vic, Australia
  4. Sunshine Coast Clinical School, Griffith University, Birtinya, Queensland, Australia
  5. Department of Neuroscience, Monash University , Melbourne, Victoria, Australia
  6. Alfred Health , Melbourne, Victoria, Australia
  7. Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, Sydney, New South Wales, Australia
  8. School of Nursing, Midwifery and Paramedic , Australian Catholic University , Sydney, NSW, Australia
  9. Eastern Health , Box Hill , Victoria, Australia

Introduction: The Australian Stroke Clinical Registry (AuSCR) supports hospitals to improve their quality of acute stroke care by providing webinars, workshops and regular feedback via interactive data dashboards and annual reports including national benchmarks.  Our aim was to describe changes in performance over time against KPIs that were commonly reported to be the focus of local quality improvement activities in hospital feedback surveys.    

Methods: An annual electronic feedback survey was issued to participating hospitals from 2022 to 2025 asking about their focus for quality improvement activities during the previous year. We compared data over time for hospitals continuously contributing ≥30 episodes per year to the AuSCR between 2021 to 2024 (n=45). 

Results:  Annual survey response rates varied from 57% to 84%. Most hospitals reported undertaking quality improvement activities during the previous year (range 78% [2023] - 93% [2025]).  Swallow screening or assessment and improving thrombolysis door-to-needle times were within the top three areas of focus each year (range 21% to 60%; and 15% to 55% respectively). 

The proportion of patients receiving a swallow screen or assessment prior to oral intake showed significant improvement over time (47% in 2021 to 60% in 2024; p<0.001).  Timely provision of this intervention within four hours of arrival improved from 26% in 2021 to 39% in 2024 (p<0.001). 

The proportion of patients provided thrombolytic therapy within 60 minutes (door-to-needle time) improved from 30% in 2021 to 43% in 2024 (p<0.001).

Conclusion: Improvements in quality of stroke care align with areas of focus for quality improvement activities, supported by performance reporting and feedback.

Relevance to clinical practice or patient experience:  These AuSCR data demonstrate alignment between quality improvement activities and improvements in adherence to key performance indicators related to improved care and outcomes for patients.