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(Stroke. 2008;39:2515.)
© 2008 American Heart Association, Inc.

Original Contributions

Factors That Influence the Stroke Care Team’s Effectiveness in Reducing the Length of Hospital Stay

Loes M.T. Schouten, Msc; Marlies E.J.L. Hulscher, PhD; Reinier Akkermans, Msc; Jannes J.E. van Everdingen, MD, PhD; Richard P.T.M. Grol, PhD Robbert Huijsman, PhD

From the Dutch Institute for Healthcare Improvement (L.M.T.S., J.J.E.v.E.), Utrecht, The Netherlands; the Radboud University Nijmegen Medical Center (M.E.J.L.H., R.A., R.P.T.M.G.), IQ Healthcare, Nijmegen, The Netherlands; and Erasmus MC (R.H.), University Medical Center Rotterdam, Institute of Health Policy and Management, Rotterdam, The Netherlands.

Correspondence to Loes M.T. Schouten, Dutch Institute for Healthcare Improvement, P.O. Box 20064, 3502 LB Utrecht, The Netherlands. E-mail l.schouten{at}cbo.nl

Background and Purpose— The purpose of this study was to explore the effects of a quality improvement program for improving stroke care and the determinants of success at the team and hospital levels.

Method— For 16 months, 23 multidisciplinary stroke service teams participated in a quality improvement collaborative designed to set up stroke services and reduce the length of hospital stay (LOHS). We monitored the LOHS and the discharge delay during the project and measured indicators of well organized stroke services at baseline and after the intervention. A multiple and multilevel regression model was used to relate the outcome variables to the team and hospital characteristics. National LOHS figures served as reference data.

Results— Data regarding 4549 stroke patients were included in the analyses. The LOHS decreased significantly from 18.3 to 13.3 days. The mean LOHS varied substantially (9.2 to 20.9 days) after the intervention. Teams with higher team functioning scores showed lower LOHS scores and higher scores for the indicators of well organized stroke services. Team characteristics explain almost 40% of the variance in LOHS and 53% in the indicators of well organized stroke care.

Conclusion— Participation in a national quality improvement collaborative effected a significant decrease of the LOHS and a significant increase in the presence of key features of stroke services. Variation in ability to reduce the LOHS and increase key features of stroke services were related to team functioning. The data suggest that the composite of team functioning is pivotal in quality-of-care improvement and may need specific attention in any quality improvement program.

Key Words: quality of health care • stroke management • outcomes • team functioning

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