Stroke mortality audit using the Structured Judgement Review method

Thomas, Jade; Saw, Kyaw Lin; Adie, Katja

doi:10.7861/clinmedicine.19-2-185

Cited by 6 publications

(4 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A United Kingdom Trust was noted to have a higher than national average mortality ratio according to a Sentinel Stroke National Audit Programme. In response, the Trust found a Structured Judgement Review for stroke deaths that was reproducible, provided data for subsequent comparisons, and focused attention on areas requiring improvement 33 . However, variability regarding levels of preventability suggests structured judgment review is better used to identify themes in causes for concern rather than preventability in individual cases 34 . More effort should be made to enhance the role of residents and fellows in M&M conferences …”

Section: Discussionmentioning

confidence: 99%

One health system’s morbidity and mortality conference survey: a step on the journey to organizational high reliability

Raper

Sullivan

Levin

2023

International Journal of Surgery: Global Health

View full text Add to dashboard Cite

Background: The goal of this study was to understand the state of morbidity and mortality conferences held throughout our health system. Assessment of current approaches is necessary for a journey toward organizational high reliability and an opportunity to reduce unnecessary variation in patient and process outcomes. Study Design: Forty-two anonymous surveys were distributed through the Health System’s Vice-chairs of Quality to those in the best position to answer questions. Answers from all departments and—where semi-autonomous—divisions were solicited. Categories, among others, included written guidelines, who presented, what events were chosen for presentation, and what was done with the data. Results: Forty-one surveys were returned. Seventeen departments or divisions have written guidelines as to which events should be reported. Twenty-two of the departmental or divisional conferences present selected cases, only 13 present all mortalities. Decisions on how events are classified are made most often by the director of Quality with 13 responses. There was no consensus on how best to enhance the clinical learning environment for residents and fellows. Conclusion: Opportunities identified by our survey to reduce practice variation include best practices for written guidelines and standardized classification formats for morbidity and mortality events. A mortality committee charged with event review and classification should be considered. Lastly, more effort should be made to enhance the clinical learning environment of trainees in event review and presentation.

show abstract

Section: Discussionmentioning

confidence: 99%

One health system’s morbidity and mortality conference survey: a step on the journey to organizational high reliability

Raper

Sullivan

Levin

2023

International Journal of Surgery: Global Health

View full text Add to dashboard Cite

show abstract

“…3 Stroke is a common cause of death in admitted patients. In these continents, in Asia (41.2%), 4 Europe (19%) 5 and Australia (14.9%) 6 admitted patients to the hospital for stroke have died. It is also commonly occurred in Africa, 7 8 29%-84% of patients who had a stroke have died and 14.3% were disabled.…”

Section: Introductionmentioning

confidence: 99%

Exploring functional abilities and competing risks among stroke patients: a longitudinal and survival analysis study at Felege Hiwot Referral Hospital, Ethiopia

Berehan,

Dessie,

Tesfaw

2024

BMJ Open

View full text Add to dashboard Cite

ObjectivesThis study aimed to evaluate competing risks and functional ability measures among patients who had a stroke.DesignA joint model comprising two related submodels was applied: a cause-specific hazard submodel for competing drop-out and stroke-related death risks, and a partial proportional odd submodel for longitudinal functional ability.SettingFelege Hiwot Referral Hospital, Ethiopia.ParticipantsThe study included 400 patients who had a stroke from the medical ward outpatient stroke unit at Felege Hiwot Referral Hospital, who were treated from September 2018 to August 2021.ResultsAmong the 400 patients who had a stroke, 146 (36.5%) died and 88 (22%) dropped out. At baseline, 14% of patients had no symptoms and/or disability while 24% had slight disability, and 25% had severe disability. Most patients (37.04%) exhibited moderate functional ability. The presence of diabetes increased the cause-specific hazard of death by 3.95 times (95% CI 2.16 to 7.24) but decreased the cause-specific hazard of drop-out by 95% (aHR 0.05; 95% CI 0.01 to 0.46) compared with non-diabetic patients who had a stroke.ConclusionA substantial proportion of patients who had a stroke experienced mortality and drop-out during the study period, highlighting the importance of considering competing risks in stroke research. Age, diabetes, white cell count and stroke complications were significant covariates affecting both longitudinal and survival submodels. Compared with stand-alone models, the joint competing risk modelling technique offers comprehensive insights into the disease’s transition pattern.

show abstract

“…Identifying the risk factors of stroke mortality is one of the most important epidemiological aspects of stroke prevention that can reduce its incidence in countries [ 10 ]. One of these factors is the timely service and transfer of patients to the hospital, as stroke requires fast and advanced medical care [ 11 ]. It has been shown that for every minute of delay in the treatment of ischemic stroke, a patient typically loses approximately 1.9 million brain cells [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Predictors of in-hospital mortality among patients with symptoms of stroke, Mashhad, Iran: an application of auto-logistic regression model

et al. 2023

View full text Add to dashboard Cite

Background Stroke is the second leading cause of death in adults worldwide. There are remarkable geographical variations in the accessibility to emergency medical services (EMS). Moreover, transport delays have been documented to affect stroke outcomes. This study aimed to examine the spatial variations in in-hospital mortality among patients with symptoms of stroke transferred by EMS, and determine its related factors using the auto-logistic regression model. Methods In this historical cohort study, we included patients with symptoms of stroke transferred to Ghaem Hospital of Mashhad, as the referral center for stroke patients, from April 2018 to March 2019. The auto-logistic regression model was applied to examine the possible geographical variations of in-hospital mortality and its related factors. All analysis was performed using the Statistical Package for the Social Sciences (SPSS, v. 16) and R 4.0.0 software at the significance level of 0.05. Results In this study, a total of 1,170 patients with stroke symptoms were included. The overall mortality rate in the hospital was 14.2% and there was an uneven geographical distribution. The results of auto-logistic regression model showed that in-hospital stroke mortality was associated with age (OR = 1.03, 95% CI: 1.01–1.04), accessibility rate of ambulance vehicle (OR = 0.97, 95% CI: 0.94–0.99), final stroke diagnosis (OR = 1.60, 95% CI: 1.07–2.39), triage level (OR = 2.11, 95% CI: 1.31–3.54), and length of stay (LOS) in hospital (OR = 1.02, 95% CI: 1.01–1.04). Conclusion Our results showed considerable geographical variations in the odds of in-hospital stroke mortality in Mashhad neighborhoods. Also, the age- and sex-adjusted results highlighted the direct association between such variables as accessibility rate of an ambulance, screening time, and LOS in hospital with in-hospital stroke mortality. Thus, the prognosis of in-hospital stroke mortality could be improved by reducing delay time and increasing the EMS access rate.

show abstract

Stroke mortality audit using the Structured Judgement Review method

Cited by 6 publications

References 4 publications

One health system’s morbidity and mortality conference survey: a step on the journey to organizational high reliability

One health system’s morbidity and mortality conference survey: a step on the journey to organizational high reliability

Exploring functional abilities and competing risks among stroke patients: a longitudinal and survival analysis study at Felege Hiwot Referral Hospital, Ethiopia

Predictors of in-hospital mortality among patients with symptoms of stroke, Mashhad, Iran: an application of auto-logistic regression model

Contact Info

Product

Resources

About