Questionnaire for Departments providing mechanical thrombectomy in the Czech Republic
Initial information:
On behalf of the Cerebrovascular Section of the Czech Neurological Society and the Czech Society of Interventional Radiology (CSIR) we would like to invite you to complete following questions. Our survey is monitoring the quality of medical care departments for patients with acute cerebral infarction in the Czech Republic.
Currently, the questionnaire has been sent to all highly specialized departments (comprehensive stroke centers) providing mechanical thrombectomy in patients with acute cerebral infarction.
The questionnaire is based on international guidelines supported by numerous international societies:
Training Guidelines for Endovascular Ischemic Stroke Intervention: An International Multi-Society Consensus Document (http://www.ajnr.org/content/37/4/E31.long) and its aim is the first systematic quality evaluation of departments providing mechanical thrombectomy in the Czech Republic, results of this survey will enable further international comparison.
Prof. MUDr. Antonín Krajina, CSc.
Doc. MUDr. Michal Bar, Ph.D.
Doc. MUDr. Robert Mikulík, Ph.D.
MUDr. Ondřej Volný, Ph.D.
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PART A – WORKPLACE – DEFINING THE PARAMETERS:
1) Have you developed a standardized procedure of care (i.e. Standard Operating Procedure / SOP) for patients with acute cerebral infarction (including the candidates for mechanical thrombectomy)?*
2a) The standard neuroimaging protocol in patients suspected of having acute cerebral infarction and large artery occlusion (i.e. those who meet the clinical criteria – the severity of the neurological deficit and indication criteria for mechanical thrombectomy) is:
(You can select/choose more than one option/answer)
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3a) The standard neuroimaging protocol in patient with a history of onset of symptoms over 6 hours (or with an unclear time of onset, for example wake-up stroke) and with suspicion of acute cerebral infarction and large artery occlusion in your department is:*
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4a) Is CT and radiographic evaluation available 24/7 in your workplace (regardless of standard imaging), in person or phone consultation?*
5a) Is MRI and radiographic evaluation available 24/7 in your workplace (in person or phone consultation)?*
6a) Is the evaluation of early ischemic changes included in radiological descriptions (e.g. using ASPECTS score – Alberta Stroke Program Early CT Score)?*
6b) If yes how is the extent of early ischemic changes evaluated?*
7a) Is evaluation of morphology of leptomeningeal collaterals part of the radiologic descriptions?*
7b) If so, please specify when:*
8) Is interventional radiologist available 24/7 in your department (phone consultation included)?
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9) Is vascular surgeon available 24/7 in your department (e.g. in case of acute carotid endarterectomy)?*
10)Is there a special angio-suite available for acute stroke patients?*
11) Is there a specialized stroke unit within the neurology clinic / department?*
PART B - THE QUALITY OF NEURO-INTERVENTIONAL PROCEDURES:
1a) Do you keep records of door-to-groin puncture times within 60 min (hospital arrival time-groin puncture)?*
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1c) If so, is the record a part of regular evaluation and quality monitoring (e.g. regular meetings of doctors involved in the treatment of acute stroke)?*
2a) Is the time parameter door-to-reperfusion <90 min documented? (Hospital arrival time-achieving reperfusion)?*
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2c) If so, is the record a part of regular evaluation and quality monitoring (e.g. regular meetings of doctors involved in the treatment of acute stroke)?*
3a) How is the achieved reperfusion assessed/scored?*
3b) Is the score part of the description neuro-interventional procedure?*
4) Who evaluates the reperfusion score:*
5a) Is the achieved recanalization assessed according to Arterial occlusive Lesion score (AOL) or revised (rAOL)?*
5b) If so, is the score part of the description of neuro-interventional procedure?*
6) Who is responsible for evaluation of the recanalization score?*
7a) Is the total number of extractions and type of device documented and monitored?*
7b) Is this information included in the description of neuro-interventional procedure?*
8a) Are any of the vascular closure devices (e.g. Angio-Seal, MynxGrip) usually used?*
9a) Is embolization into new territory during the procedure and on the final DSA documented and monitored?*
9b) Is this information included in the description of neuro-interventional procedure?*
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10) Are the peri- and post-procedural complications monitored (e.g. dissection of internal carotid artery, vasospasm, symptomatic intracerebral haemorrhage, etc.)?*
11a) Does analgosedation precede general anaesthesia in patients who absolutely require general anaesthesia (i.e. agitated patient, cardiopulmonary unstable)?*
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12) Are DSA images exported (initiation, progress and final run) into PACS:*
13a) Are data about mechanical thrombectomies imported to one of the national or international registries?*
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PART C - NEURO-INTERVENTION TRAINING
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2a) Are physicians of other specialization than radiology trained in neuro-interventions (e.g. neurosurgery, neurology)?*
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PART D - THE DIFFERENCES BETWEEN CARE PROVIDED ”DURING OFF-PEAK HOURS AND AT THE WEEKENDS"
Is there any difference in quality of care provided in optimal condition (experienced physician, working time) and completely opposite condition (less-experienced physician after hours / weekend)?
Rate on a scale from 0 to 10 (0 - no difference in the quality of care, 10 - fundamental difference (e.g. thrombolysis is not administered in the indicated patient, patient indicated for MT in the primary stroke centre is rejected etc.):
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After-care:
Could you, please, estimate how difficult is to transfer the patient to subsequent care:
range 0 to 10 (0 - no problem with early transfer, 10 - very difficult to transfer the patient despite a reasonable period of hospitalization - max. 2 weeks).
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