IMPLEMENTATION AND TEMPORAL VARIABILITY OF GUIDELINE-RECOMMENDED ACUTE STROKE CARE AT A TERTIARY UNIVERSITY CENTER: A RES-Q REGISTRY ANALYSIS
Keywords:
stroke, RES-Q registry, performance indicators, thrombolysis, stroke systems of careAbstract
Introduction: Although guideline-recommended performance indicators for acute stroke care are well established, their consistent implementation in routine clinical practice over time remains challenging. Registry-based analyses allow evaluation not only of performance levels, but also of temporal variability and system-level performance.
Aim:To evaluate the implementation and temporal variability of guideline-recommended acute stroke care indicators and early discharge outcomes over one year using RES-Q registry data from a tertiary university hospital.
Material and methods: A retrospective analysis of prospectively collected RES-Q registry data was performed for all consecutive stroke patients admitted at the Department for Urgent Neurology at the University Clinic for Neurology between 1 January and 31 December 2025. Demographic characteristics, admission severity, imaging performance, acute treatment metrics, in-hospital care indicators, and discharge management were analyzed descriptively using quarterly aggregated data.
Results: A total of 179 stroke patients were included. Neuroimaging was performed in 100% of cases throughout the study period. Intravenous thrombolysis rates varied between 7% and 43%, while endovascular treatment was performed in up to 20% of patients in selected quarters. Median door-to-needle times ranged from 48 to 180 minutes, demonstrating marked temporal variability. Adherence to discharge care indicators was high, including swallowing screening (90–100%), anticoagulation in patients with atrial fibrillation (92–100%), and antithrombotic therapy in non-AF patients (82–100%). Median discharge modified Rankin Scale scores ranged from 4.0 to 5.0.
Conclusion: Continuous registry-based monitoring is essential to identify system-level fluctuations and to support sustainable improvements in stroke care delivery.
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Copyright (c) 2026 Anita Arsovska, Jovan Bozhinovski, Aleksandra Angelova, Fatjona Kolari, Atifete Jakupi, Jasmina Mitrevska Velkov, Fatmir Mexhiti, Petar Janevski
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