Brazilian Intervention to Increase Evidence Usage in Practice - Stroke (BRIDGE-Stroke) (BRIDGEStroke)

Experimental: Multifaceted Strategy

Comportamental: Multifaceted Strategy

1. Simulation Based Team Training
2. Case Manager: a trained person who works in the hospital and is responsible for ensuring the usage of all interventions
3. Reminders -
4. Check lists - decision support algorithm
5. Distribution of educational materials: guidelines and recommendations for best practices

Sem intervenção: Usual Care

Hospital Standard Treatment

Frequency of Evidence Based Strategies

For phase 1: Proportion of prescription of evidence-based strategies. in the first 48 hours and prior to discharge

Composite Adherence Score

Composite Adherence Score: defined as the sum of usage of evidence based therapies in the first 48 hours and at discharge among the patients' total eligible opportunities. For this purpose, patients with contraindications (which are specific for each endpoint) were excluded from the denominators. Evidence based therapies in the first 48 hours include: antithrombotics within 48 hours of admission, use of recombinant Plasminogen Activator (Rt-PA)in patients who arrive at the hospital within 3.5 hours of symptom onset and who are treated within 4.5 hours of symptom onset, dysphagia screening, pre-deep venous thrombosis prophylaxis, door to needle time < 60 minutes, dysphagia screening). Discharge Therapies include: antithrombotics, lipid lowering agents in patients with LDL 100 or not documented, anticoagulants for atrial fibrilation or flutter, assessment for rehabilitation and smoke cessation education

"All or None" Quality Measures

Proportion of prescription of evidence-based strategies in the first 48 hours and at discharge "All or none" measures including the evidence based therapies in the first 48h: antithrombotics, use of recombinant Plasminogen Activator (Rt-PA)in patients who arrive at the hospital within 3.5 hours of symptom onset and who are treated within 4.5 hours of symptom onset, dysphagia screening, pre-deep venous thrombosis prophylaxis, door to needle time < 60 minutes, dysphagia screening). Discharge Therapies include: antithrombotics, lipid lowering agents in patients with LDL 100 or not documented, anticoagulants for atrial fibrilation or flutter, assessment for rehabilitation and smoke cessation education

Additional Strategies

Proportion of usage of the additional strategies: use of recombinant Plasminogen Activator (Rt-PA), anti-hypertensive agents, and door to needle time< 45 min)

Total Mortality

In hospital and 90 days mortality

Disability

Degree of disability (measured by the Modified Rankin Scale) at discharge and in 90 days.

Stroke Recurrence

Number of patients presenting a new stroke in 90 days