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(Stroke. 2003;34:e158.)
© 2003 American Heart Association, Inc.

Letters to the Editor

Re: Relationship Between Process and Outcome in Stroke Care

Stroke Program, Swedish Medical Center, Seattle, Washington, Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire

William H. Likosky, MD Tammy L. Cress, RN, MSN

Stroke Program, Swedish Medical Center, Seattle, Washington

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

We read with great interest the recent article by McNaughton and colleagues¹ regarding the relationship between clinical processes and outcomes of stroke care in the setting of 3 hospitals in New Zealand.

Stroke may have devastating outcomes for patients, families, and society. The hypothesis that understanding clinical care processes may lead to sustainable changes that would favorably impact the clinical outcomes of that care is an important one. McNaughton and colleagues’ null findings should not stymie continued efforts to reflect on current practice and its inevitable impact on outcome. Opportunities to improve care abound as many institutions have yet to implement currently published guidelines.

Our group has been especially interested in the relationship between stroke units, processes of clinical care in those units, and patient outcomes.² We are situated in a regional referral center with an open physician’s admission program, which in many ways reflects community practice outside of universities and institutes. The Stroke unit is not a unitary location, but is represented in the emergency department, in the neuro-intensive care and telemetry units, and in the general neurology ward. A physician may actually admit only very few, if any, stroke patients during any given year. This limited physician experience may ultimately impact his ability to reflect on daily practice or to gain the expertise to manage a stroke patient optimally. At the same time, the interaction among physicians, nurses, and ancillary staff with regard to these patients, while often understudied, is quite important. Related areas of . . . [Full Text of this Article]