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QJM Advance Access originally published online on February 27, 2006
QJM 2006 99(4):267-272; doi:10.1093/qjmed/hcl020
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© The Author 2006. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Commentary

Towards effective and efficient care pathways: thrombolysis in acute ischaemic stroke

J.D.H. van Wijngaarden, M. Dirks, D.W.J. Dippel, M. Minkman1 and L.W. Niessen

From the Erasmus University Medical Center, Department of Neurology and 1Institute of Policy and Management in Health Care, CBO Dutch Institute for Health Care Improvement, Rotterdam, The Netherlands

Address correspondence to Dr J.D.H. van Wijngaarden, Room L4-62, PO Box 1738, 3000 DR Rotterdam, The Netherlands. email: j.vanwijngaarden@erasmusmc.nl

The first 150 words of the full text of this article appear below.


   Introduction
 
Over the past decade, specialist services for stroke patients have been introduced, and evidence suggests that they are both effective and efficient. 1–5 In many European countries, these services consist of stroke units in hospitals, rehabilitation facilities and community care organizations. In such networks, health professionals and organizations must coordinate their work to ensure that patients receive appropriate timely care, in appropriate settings. However, the pathway from stroke onset to hospital treatment is often far from seamless. Many stroke patients are admitted too late for appropriate treatment, or not at all. With the increasing effectiveness of acute stroke unit care and of thrombolysis, it is vital that this situation changes. If patients with an acute ischaemic stroke receive thrombolytic therapy within 3 h, they have an increased chance of recovery with a good outcome. 6 We therefore need to identify and use tools and strategies for creating an effective and efficient continuum . . . [Full Text of this Article]


   What is the evidence for the effectiveness of thrombolysis?
 

   The problem: under-performance of thrombolysis services in acute stroke
 

   What are the specific problems in creating a continuum in stroke care?
 
Outside the hospital
Hospital procedures and medical judgment

   Why is a successful service difficult to set up?
 

   How to improve impact?
 
An ongoing Dutch trial
Possible interventions to promote higher impact
Implementation strategy
The intervention

   How to assess the effectiveness of organizational interventions?
 

   From trial to implementation strategy for care pathways
 

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