Organizational Clinical Pathways

All patients with stroke or suspected stroke benefit from integrated stroke care systems which are created following the recommendations in the guidelines of the American Heart Association (AHA)/American Stroke Association (ASA) [1]. These care systems include hospitals for treating acute stroke, which often offer telemedicine and teleradiology, comprehensive stroke units, emergency units, public agencies and government resources. The objectives are prevention of stroke, optimal use of emergency departments, treatment of acute and subacute stroke, rehabilitation and follow-up, as well as educational programmes. Randomized clinical trials have shown that patients treated in primary stroke centres have a better outcome than patients treated in facilities without a stroke unit and that the rate of thrombolysis is higher; thus in the AHA/ASA guidelines, the creation of primary stroke centres is recommended (Class I, Evidence Level B), pointing out that these centres must be certified by an external organization. They further recommend setting up a multidisciplinary “improvement and quality” commission for reviewing and monitoring quality indicators, such as quality of care, evidence-based practice and prognosis (Class I, Level of Evidence B), in order to identify any deficiencies and to arrange to have them corrected.