AVALIAÇÃO DA QUALIDADE DO ATENDIMENTO DO DOENTE COM ACIDENTE VASCULAR CEREBRAL ISQUÉMICO AGUDO DO HOSPITAL SANTO ANTÓNIO DO PORTO

Abstract

Introduction: Ischemic Stroke results from the obstruction of a blood vessel supplying part of the brain, leading to an acute focal neurological deficit. It is one of the main causes of morbidity and mortality worldwide and a major cause of functional disability. Its ideal treatment is mechanical thrombectomy, which enables recanalization of the occluded vessel. This treatment must be performed as early as possible after symptom onset. However, technical skill alone from the different team members is not enough-success requires a multidisciplinary approach and, above all, a well-coordinated team; that is, the way the different members communicate and share knowledge among themselves, from reception to intervention and follow-up of the patient. Objectives: This study aims to assess the association between technically successful recanalization and favorable clinical outcomes in the endovascular treatment (thrombectomy) of acute ischemic stroke, and to analyze the perceptions of the members of the Stroke Care Teams ("green pathway") at Santo António Hospital in Porto regarding collaborative practice. Methodology: The project includes two studies: An evaluation of the quality of care for patients with acute ischemic stroke, carried out as a quantitative, observational, descriptive, retrospective study of patients treated by endovascular means (thrombectomy) for acute ischemic stroke at the Neuroradiology Department of Santo António Hospital in 2022 and 2023; An assessment of collaborative practice among team members, carried out as a quantitative, observational, descriptive study on the perceptions of stroke team professionals regarding collaborative practice, using an online questionnaire based on the Assessment of Interprofessional Team Collaboration Scale (AITCS II). Results: Of the 254 patients included in the study, 150 (59.1%) were female and 104 (40.9%) male; the mean age was 72.5 (±13.8). Good recanalization was achieved in 231 (90.9%) cases, obtained in a single pass in 144 (56.7%). A favorable functional outcome at 90 days was achieved in 134 (52.8%) cases. Good recanalization did not correspond proportionally to good clinical outcomes at 90 days: although 90.9% of cases achieved good recanalization, only 56.3% of these had favorable functional outcomes at 90 days. Conversely, 82.6% of patients with poor recanalization had unfavorable functional outcomes at 90 days. There is an association between poor clinical outcomes at 90 days and poor recanalization (Odds Ratio, OR, 7.2 times higher than the reference class mTICI ≥2B), ASPECTS <6 (OR 33.6 times higher than the reference class ASPECTS ≥6), use of a Stent Retriever (OR 1.9 times higher than the reference class without Stent Retriever), and age-considering the reference class ≤55 years, the OR is 5.8 times higher for the 71-75 group, increasing to values above 20 for the 81-85 and ≥86 age groups. Professionals attributed the highest values, under partnership, to the use of "cohesive and consistent communication to discuss patient care," often 6 (40%) and always 7 (46.7%); under cooperation, to "the understanding that knowledge and skills are shared among the healthcare professionals in the team," often 12 (80%) and always 3 (20%). However, they expressed divergent views regarding coordination, particularly in encouraging and supporting "open communication, including patients and their families in team meetings," rarely 6 (40%) and often 6 (40%). Conclusion: Poor clinical outcomes at 90 days are associated with poor recanalization (mTICI <2B), ASPECTS <6, use of a Stent Retriever, and age-especially in the older age groups. Regarding collaborative practice, professionals value most highly the domains of partnership and cooperation, though some divergence exists regarding coordination. Keywords: stroke, ischemic stroke, mechanical thrombectomy, interprofessional collaboration, quality.