IF you were asked to name a critical year for stroke care at Torrecárdenas University Hospital, and you answered 2021, you would be right. Because that was the year this hospital in Almería treated 120 ischaemic stroke patients with reperfusion therapy, raising the recanalisation rate to 40 percent. It was also the year it won its first ESO Angels diamond award.
If you answered 2019, you would still be right, because that was the year the average door-to-needle time dropped past 40 minutes – 20 minutes below the target it had set itself.
If you said 2018, of course you’d be right, because that was the year a stroke unit with five beds opened in October, and Torrecárdenas University Hospital became the referral centre for a local stroke network.
If you said 2017, you’d be right, because that was the year the first stroke patients at this hospital were treated at CT.
If you said 2016, you would be spot on, because that was the year a highly skilled neurologist came home to Almería. One of the first things Dr Patricia Martínez Sánchez did after arriving from Madrid was to create a stroke protocol at Torrecárdenas University Hospital.
And if you answered 2013, you wouldn’t be wrong. Because that was the year Joaquín Alberto García Gálvez became chief neurology nurse at Torrecárdenas University Hospital, an experienced nurse whose profession was also his calling.
DOCTOR Martínez returned to Almería via the Complutense University of Madrid where she studied medicine, and Madrid’s Hospital Universitario La Paz where she specialised in neurology.
La Paz had one of the first stroke units in Spain, led by the renowned Prof Exuperio Díez Tejeor and his successor Dr Blanca Fuentes. It was under their tutelage that she decided to dedicate herself to cerebrovascular diseases.
When Dr Martínez joined Torrecárdenas University Hospital in 2016, it had no stroke unit and no stroke protocol. Today, this same hospital has a 24/7 neurology on- call and interventional neurology team, and rehabilitation doctors, physiotherapists, speech therapists and occupational therapists in the stroke unit. Its recanalisation rate has increased by 400 percent.
Almería’s 70,000 inhabitants are now served by a provincial stroke network that consists of a comprehensive stroke centre (Torrecárdenas University Hospital) and two stroke- ready regional hospitals. Responsibility for the optimal flow of patients between hub and spokes rests with the Provincial Stroke Committee of which Dr Martínez is the coordinator.
At Torrecárdenas itself, a record is kept not only of door-to-needle and door-to-groin times, but of every minute that ticks by in every pathway component from onset to treatment. This has lead to refinements such as blood samples being collected in the ambulance, and steps to ensure tests aren’t repeated. When the patient arrives in the emergency department a timer is activated to measure the minutes that elapse before the gurney is wheeled to the CT scanner.
Arguably the biggest impact on treatment times has come from treating at CT, which officially became part of the stroke protocol in 2021, also the year Angels consultant Alicia Arjona lead the Torrecárdenas team in a simulation training, and the FeSS protocol was implemented in post-acute care.
WHEN Alicia got to know Joaquín García Gálvez in 2019, she immediately recognised a bright spot who could help her transform stroke care in Andalusia. The
chief nurse from Torrecárdenas University Hospital was an unsung superhero whose advocacy for stroke patients included campaigning for interventions such as treating at
CT and participation in the QASC trial and ESO Angels Awards. He, along with Raimuna Caro Quesada from Seville, would play a key role in the Andalusian Nurses Steering Committee, formed during the pandemic to standardise stroke nursing care the region.
Joaquín is a believer in data-driven improvement who led the charge to enrol Torrecárdenas University Hospital with RES-Q, a registry purpose-built to monitor the most important quality measures for stroke care. By recording the impact of improvements implemented by Dr Martínez, this intervention propelled Torrecárdenas University Hospital into very select company.
Hospitals that capture treatment data in RES-Q automatically become eligible for an ESO Angels Award. To determine their award status, their performance is evaluated against a set of awards criteria that correspond with clinical guidelines.
The awards criteria also function as a checklist for hospitals committed to improving outcomes for their patients, and as a mechanism for identifying and targeting gaps in stroke care quality.
“It’s a very useful tool,” Joaquín says. “It allows you to reflect in a graphic way, supported by data, the level of quality offered to your patients. It’s the best way to analyse performance, look for areas where you can improve, and develop strategies to reach tangible objectives in the care of our patients.
“The changes at our hospital since 2019 have been tremendous, and winning the award in 2021 confirmed something we already knew – that our hospital works very well.”
That first diamond award made their success known to their community, Dr Martínez says. “It is important for patients and relatives to know they’re being cared for in a hospital that has been recognised for excellence.
"It is also a great source of pride that a hospital from a small province in Spain can deliver the same standard of care as those in the capital cities of Europe. It has been very, very positive."
There can be no doubt that 2021 was a good year for stroke care at Torrecárdenas University Hospital. But if you had to pick the best year for stroke care at this hospital, that might be 2022, the year its stroke team proved that they were capable not only of reaching the highest level of performance but also of staying there.
Winning its second diamond award (for Q4 2022) makes Torrecárdenas University Hospital one of just two hospitals in Spain that have reached this distinction. It remains the only award-winning hospital in Andalusia.
