ESO East Supplement 2023 - 57

Gdovinova et al.
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stroke-ready hospitals and optimize the quality of treatment
in all existing stroke centers. To date, each hospital in
Slovakia has received at least the ESO Angels gold award,
and many have repeatedly won the highest diamond award.
In the future, we would like to improve the quality and
accuracy of the collected data, so we are working to ensure
that the data is transferred directly from the structured discharge
report, thus ensuring that really all patients are
reported and reducing the error rate that can always be present
at rewriting the data in the register. The program is
already ready and the Ministry of Health has promised to
support this project.
The achievement of a structured organization of acute
stroke management was confirmed during the Covid-19
pandemic. During the first wave, when Slovakia had a low
incidence of Covid-19, as well as during the second wave
when Slovakia was among the countries in the world with
the highest incidence of Covid-19, the acute stroke management
stroke did not differ.9,10
The challenges of pre-hospital stroke management can
be divided into two main groups: the patients themselves
and their families and the emergency medical services
team. Cooperation with EMS has improved significantly;
therefore, we decided to spread knowledge of stroke among
the population. Stroke educational campaigns were one
solution for improving patients' and families' awareness of
stroke symptoms and the correct response in the case of
stroke. We started the " time is brain " campaign, which is
well known in other countries, collaborating with the
" Second for Life " patient organization. However, such
campaigns have been shown to have a short-term impact,
and constant repetition of their message is a central precondition
for their success. After each campaign, we registered
a higher number of patients who arrived on time; therefore,
public education efforts are worthwhile, and future efforts
should focus more strongly on specific target groups, such
as the elderly, minorities, neighbors, people who have survived
a stroke, medical students and even children (who
may be future relatives, patients, or doctors). Finally, the
previously mentioned Angels Initiative was implemented.
In acute care, we have already achieved and exceeded
the quality parameters set by the Stroke Action Plan for
2018-2030.4 Nevertheless, even in acute care, it is necessary
to improve the technical and personnel equipment,
which we are trying to address with the Ministry of Health
in the ongoing health care reform.
In the Helsingborg Declaration of 2006, the goal for
2015 was that all stroke patients in Europe would have
access to a continuum of care, from acute management to
appropriate rehabilitation, delivered in dedicated stroke
units. The Action Plan for 2018-2030 for Rehabilitation
includes occupational, physical, and speech and language
therapy, with input from psychologists and social workers.
This should involve a multidisciplinary approach in a
comprehensive stroke team and an ordered plan after discharge
from the hospital, with documented responsibility
for continuing rehabilitation needs in the community. In
this area, we still have many deficiencies, and the improvement
of rehabilitation and post-stroke care in all its areas
is the subject of the ongoing health care reform.4
The strengths of the presented results are (1) that we
have achieved changes throughout Slovakia in all stroke
hospitals, (2) there is now a mandatory stroke register in
Slovakia, and as a result, we have available data on monitored
quality parameters for all hospitals, and (3) data from
our register are compatible with the international register.
A limitation of the presented study is the quality of the
registry data since the stroke physicians themselves enter
all the data in addition to their working duties, which may
result in inaccuracies. Our goal is to automatically transfer
the data from patient records in the hospital information
system into the registry.
Conclusion
Due to the change in stroke management over the last
5 years, we have reduced the time for acute stroke treatment
and improved the proportion of patients with acute treatment,
and in this area, we have achieved and exceeded the
goals of the Stroke Action Plan for Europe for 2018-2030.
Nevertheless, we still have many insufficiencies in stroke
rehabilitation and post-stroke nursing that need to be
addressed.
Acknowledgements
Acknowledgments belong to all doctors and nurses who take part
in the care of stroke patients in Slovakia and who give data to the
stroke register. Our thanks belong to Dr. A. Barakova, MD and
Dr. A. Cvopová, MD for keeping the stroke register and data
processing.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
Ethical approval
The ethics committee of Faculty of Medicine P. J. Safarik
University approved using data from stroke registry.
Informed consent
Informed consent was not required. Anonymized data from the
mandatory stroke register were used.
ESO East Supplement 2023

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