ESO East Supplement 2023 - 56

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European Stroke Journal 8(1S)
Figure 5. The most important procedures for improving stroke care in Slovakia.
collection and enables the acknowledgment of the best performing
pre-hospital stroke care providers.
The Angels Initiative and the patients' association implemented
in the country the Fast Heroes campaign supported
by the World Stroke Organization (WSO), which aims to
raise awareness of key stroke symptoms among children,
encouraging them to share the knowledge with their relatives.
In the first year of the Fast Heroes campaign in
Slovakia, 143 schools with more than 5500 children were
enrolled, and 300 teachers were involved. As a result, 90%
of parents expressed higher confidence about what to do if
somebody has a stroke.
Discussion
Our results indicate that it is possible to change stroke management
(reduce DTN time for thrombolysis, increase the
proportion of patients treated by thrombolysis and
thrombectomy) at a single hospital and national level.
Previous unsatisfactory results, especially the low rate
of recanalization and longer time to treatment in patients
with acute stroke, led the Slovak Stroke Society to change
the management of stroke.
Implementing the changes was not easy. Most of the
changes were achieved thanks to the enthusiasm of doctors,
nurses, paramedics, and emergency services, without significant
support from state authorities or the Ministry of
Health. Engagement was identified as a key facilitator for
improving stroke care, and the Slovak Stroke Society has
developed a network of hospitals for primary and secondary
stroke care. Still, it took 2 years to be officially recognized
by the Ministry of Health, together with National
Guideline for Stroke Care.
Creating a network of stroke centers was crucial to
improving cooperation with emergency services so that
crews could transport patients directly to a stroke-ready hospital.
The second key moment was the introduction of prenotification,
which made it possible to obtain essential data
about a patient before his or her arrival at the hospital and to
enter a patient's individual data into the hospital information
system. We relied on proven procedures, such as the
Helsinki6,7 or Czech model of stroke care,8 such as cooperation
with the emergency medical service, prenotification,
hospital stroke team education and achieving CT priority.
It was challenging to convince radiologist that each
stroke patient requires non-contrast CT and CT angiography.
Nowadays, we are in the process of explaining the
need for CT perfusion to extend the window for IVT and/or
EVT. The administration of alteplase bolus on the CT table
reduced the DNT, especially during regular working hours.
Before becoming a routine action, it had been topic of
repeated discussions with CT staff and nurses.
Despite all our activities, seminars, and lectures at conferences,
reducing the door-to-needle time and increasing
the rate of intravenous thrombolysis to the required level
was achieved only in some hospitals, and significant interhospital
differences persisted. And far too many stroke
patients still arrive to hospitals outside of the time window
for acute treatment.
We presented data on the differences between hospitals
at professional events, but this did not significantly improve
either management or data entry, which was still insufficient
in some hospitals. In cooperation with the patient
organization " Second for Life, " the situation changed when
we began to present the register results at press conferences.
Since then, data entry has improved, which was
impossible several years before. At the same time, hospitals
have begun to address their internal problems in stroke
management.
For continuous and further improvement, regular quality
monitoring is necessary; therefore, the results of stroke hospital
management are presented regularly once a year. At the
same time, they are entered into the international register for
comparing the quality of management at the international
level. Slovakia has become part of the ESO Angels initiative,
which aims to increase the number of patients treated in
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