The global COVID-19 pandemic has forced stroke leaders to reconsider multiple aspects of program management and patient care.  As a result, process improvement initiatives, routine meetings and attention to outcome data were paused by many organizations.  As we return to a new normal, we have an opportunity to evaluate routine stroke program data to better understand the local, regional, and even national impact of the pandemic on stroke care and outcomes.

As you plan your approach, consider these suggestions for data evaluation:

• How were your stroke volumes impacted by the pandemic, and have your volumes recovered or even surged after an initial decrease? Simple volume trends may impact patient outcomes, care processes, and impact the financial health of the organization.  Many leaders report an initial decrease in patient volume, followed by a rebound and, in some cases, a larger volume of patients in the summer and early fall.  How do stroke volumes in your program compare? And if you are a telestroke provider, how were consultations and transfers affected?

A retrospective review of stroke program data from nineteen (19) Cleveland Clinic emergency rooms in Northeast Ohio showed a decline in stroke presentations to the ED during the COVID-19 surge. You can view the article at:

https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.030331

A CDC report on June 26, 2020 reported national surveillance data that showed, in the 10 weeks after a national COVID-19 emergency was declared, there was a 20% decrease in stroke ED visits. You can view the article at: https://www.cdc.gov/mmwr/volumes/69/wr/mm6925e2.htm

Cooper University Hospital (CUH) in southern New Jersey is a Comprehensive Stroke Center providing telestroke services to five (5) referring Primary Stroke Centers in their region. They reported post-pandemic declines in stroke consultations, referrals, walk-ins and EMS arrivals. You can view the article that includes more details of their experience at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7221408/

• Have you seen a change in your door-to-needle and/or mechanical thrombectomy times? Did the strain of COVID-19 on your hospital and staff, struggling to manage surges in patients, impact processes in your emergency department and procedural areas?  Have your processes recovered? Alternatively, did your program continue to implement efforts to decrease door-to-needle times to under 30 minutes or door-to-puncture times to under 60 minutes? And did virtual clinician guidance for stroke alerts in your institution impact timeliness of care?

In this article, three Connecticut hospitals report time metrics and early outcomes were preserved during the period where new safety measures for patients and staff were being implemented. You can view the article at: https://www.ahajournals.org/doi/10.1161/STR.0000000000000347

• If you saw a decrease in stroke patient volume for a period of time, did you see any associated change in acuity at admission or discharge, or mortality? We advise caution here as mortality trends are best studied across large patient populations and may not be evident in individual organizations. Still, it is worth examining your data for trends.

In this article, California Irvine Medical Center studies pre- and post- COVID-19 stroke patient acuity in the ED, at discharge and mortality rates. They also reviewed treatment times and rates. You can view the article at: https://www.frontiersin.org/articles/10.3389/fneur.2020.00850/full

Articles mentioned above discuss their findings in these areas as well.

• How has the pandemic impacted your length-of-stay (LOS)? Did it shorten due to efforts to reduce inpatient exposure or shorter waiting lists for imaging or other tests? Was it impacted by additional capacity at rehab facilities or were transfers delayed as post-acute facilities also struggled to manage COVID-19 infections? Has it changed more recently? Do you need to adjust your LOS goals for the near future based on local issues?

Articles mentioned above discuss their findings in these areas.

• Was there any measurable regional impact of the pandemic? If you submit data to a regional or state organization, how do you compare?
• With more people at home than ever before, are you having more success reaching patients post-hospitalization to obtain follow-up outcome data?

As stroke programs are required to collect a large amount of process and outcome data, take the time to understand the impact of the pandemic on your program and your patients. As more programs regain traction in abstracting stroke data, it is even more important to benchmark with others and to talk with your team and organizational quality experts to evaluate your data and trends in light of the pandemic. Has your program stabilized or do you need to work to get back on track?

Join the conversation! Please share any measurable changes you’ve seen in your program and/or performance improvement efforts and successes on our Facebook page:  https://www.facebook.com/strokechallenges