Personnel at most hospitals that treat acute stroke, particularly the lowest-performing hospitals, greatly overestimate their ability to deliver TPA to eligible patients within 1 hour, according to a report published online July 22 in Journal of the American Heart Association.
Overestimating the quality of care they actually provide may perpetuate this suboptimal performance, “whereas accurate measurements of current performance and realistic comparison to other, more successful, sites might provide the needed motivation to fuel quality improvement,” said Dr. Cheryl B. Lin of Tufts Medical Center Floating Hospital for Children, Boston, and her associates.
Copyright American Stroke Association
They compared stroke teams’ perceptions of their door-to-needle performance, as measured on survey questionnaires answered by nurses, neurologists, and other staff members, against the hospitals’ actual performance, which was recorded in a large stroke registry. The investigators focused on 141 hospitals that treated 48,201 stroke patients during a 1-year period. This included 49 top-performing, 52 average-performing, and 40 low-performing hospitals. The top category had door-to-needle rates of 45%-93%, while the bottom category had consistent door-to-needle rates of 0%. The middle category had door-to-needle rates of 16%-25%.
Regardless of their hospital’s performance category, 61% of the respondents overestimated how many eligible patients there actually received TPA within 1 hour. The lowest-performing hospitals had the most unrealistic estimates, with 68% of them guessing that 20% of their patients received timely TPA when in fact 0% of patients did so. Low-performing hospitals also overestimated their performance in comparison with other hospitals, with 85% of them characterizing their performance as average, above average, or even superior relative to other hospitals, when in fact it was very poor, Dr. Lin and her associates wrote (J. Am. Heart Assoc. 2015 July 22 [doi:10.1161/JAHA.114.001298]).
“Addressing misperceptions that one’s performance is average or above average when it actually is not is an important step in addressing motivation for change,” they added.
The study was supported by the U.S. Agency for Healthcare Research and Quality. Dr. Lin reported having no relevant financial disclosures; her associates reported ties to Genentech, Lilly, Johnson & Johnson, Bristol-Myers Squibb, Sanofi-Aventis, and Merck Schering-Plough.