Time-critical quality assessment of a digital hub for acute stroke care: Implementing key performance indicators within the CAEHR (CArdiovascular diseases – Enhancing Healthcare through cross-sectoral Routine data integration) project

Purpose Timely treatment for acute stroke requires rapid admission to specialized centers, which is challenging in rural areas. Hereby we report: the conceptualization of implementing digital interfaces to improve time-critical communication between Emergency Medical Services (EMS), regional hospitals, and stroke centers; the development of key performance indicators (KPIs) for pre-hospital stroke care; and the experience of a proof-of-concept pilot study. Method Within the CAEHR (CArdiovascular diseases – Enhancing Healthcare through cross-sectoral Routine data integration) project, three HL7/FHIR compliant interfaces were conceptualized to enhance communication between EMS, regional hospitals, and the stroke unit at the University Hospital of Würzburg based on experiences of a telemedical network in rural Northwest-Bavaria. To prepare the evaluation of the impact of these interfaces, a standardized set of KPIs for pre-hospital stroke care was developed and piloted regarding feasibility within a proof-of-concept pilot study. Results An interface enabling real-time exchange of EMS pre-notification and protocols was developed to improve EMS-to-stroke center communication. Another interface linked PACS systems of regional hospitals with the stroke unit to facilitate faster image transmission. 27 KPIs for measuring acute stroke care quality were defined by a multidisciplinary group using a standardized evidence-based approach. In a proof-of-concept pilot study comprising 25 patients, KPIs demonstrated feasibility regarding implementation and patient follow-up. Conclusion Digital interfaces to improve time-critical communication in acute stroke care were successfully conceptualized. A larger validation study is required to assess their impact on pre-defined quality measures in pre-hospital stroke care. Study registration The study was registered on the German Clinical Trials Register (DRKS00029103) in July 2022 DRKS ID DRKS00029103