11 Nov The Role of Decision Support in Stroke Care
Clinical decision support tools have long been used to reduce variance in care, as they help healthcare providers implement evidence-based medicine right at the patient’s bedside. They are particularly critical when treating stroke patients, as decision support systems can provide updated guidelines for stroke care, leading to improved patient outcomes and reduced costs.
Stroke is a significant public health problem, as it remains the fifth leading cause of death and a leading cause of disability in the United States. Each year, over 790,000 patients have a new stroke. Approximately 80% of strokes are ischemic in nature, meaning that they are caused by a blood vessel blockage resulting in a lack of oxygen to the surrounding brain tissue. 20% of strokes are hemorrhagic, meaning that there is bleeding into the brain tissue.
Decision-support tools that are well-developed, user-friendly, and evidence-based can be especially welcomed by emergency medicine physicians, non-stroke neurologists, internists, intensivists, and nursing staff in hospitals that provide stroke care but without constant stroke expertise on site. This applies to a majority of community and rural hospitals.
Tertiary, academic centers, and comprehensive stroke centers may also utilize decision-support tools for quality improvement initiatives instead of clinical guidance. This approach is well-suited to the domains of acute management of ischemic stroke and TIA, in-hospital care, and secondary prevention of acute stroke and TIA, acute and in-hospital care of intracerebral hemorrhage.
One example of how guidelines for the acute management of stroke can improve outcomes is in mechanical thrombectomy, which is a therapy for treating acute stroke in which a clot is removed from a large artery in the brain. Before 2016, there was no evidence showing improved outcomes in patients treated with mechanical thrombectomy; however, the current level 1 guideline recommends mechanical thrombectomy in certain patients. With an increased number of providers referring to the latest clinical guidelines, there has been an increase in the number of these procedures performed, which has led to patients getting the appropriate level of care and an overall stronger system of stroke care.
By incorporating the latest clinical guidelines into decision support software, providers and clinicians can also reduce medical errors and improve their performance when providing stroke care. In doing so, healthcare systems will continue to see improved patient outcomes, reduced costs, and improved experiences for both patients and providers.