ESO East Supplement 2023 - 40

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European Stroke Journal 8(1S)
Figure 4. The trend of indicators according to the ANGELS Initiative quality improvement program in Estonia from 2017 to 2021
according to the Registry of Stroke Care Quality data (AF: atrial fibrillation; ICU: intensive care unit; CT: computer tomography;
MRI: magnetic resonance imaging).
achieved by the help of governmental-level decision in 2019
which demands that all stroke patients are transported
straight to stroke-ready hospitals. However, there are no certified
stroke units in Estonia as this is not required by the
payor and the government. One of the obstacles is the fact
that Estonia as a very small country cannot afford separate
stroke units even in large hospitals. Stroke patients are
treated in neurological departments usually by general neurologists.
However, approximately 80% of all hospitalized
neurological patients have stroke. Future plans include ESO
certification for all stroke-ready hospitals in Estonia, however
the very strict criteria might become an obstacle.17
It is important to mention, that DNT-s are good in all
stroke-ready hospitals and somewhat better than the goal of
30 min set by the RES-Q. The time logistics has probably
been affected by COVID-19 pandemic and by the implementation
of extended time window for IVT and MT since
2019 with the help of CT perfusion Rapid AI in three and
emergency MRI in one hospital.18 On the other hand, this
has provided the access for recanalization therapies for a
larger number of patients. The need for improvement of the
ODT has been recognized and all hospitals work on defining
the gaps and solutions for improvement.
The 30 days mortality is slowly decreasing. This may be
related to better primary prevention and stroke unit care.
The results of the indicators according to the Angles award
program are not yet ideal and show that educational activities
for the whole staff are needed for implementation of the
results of evidence-based medicine into clinical practice.16
The importance of teamwork in improving stroke care
quality cannot be underestimated. Tartu University Hospital
participated at the Quality in Acute Stroke Care Europe
Project and the results show that more attention should be
paid to the improvement of nursing care by training and

ESO East Supplement 2023

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