Patient experience and stroke care quality: a quality improvement initiative in Northeastern Ontario.

Abstract

Background: Patient-reported experience measures (PREM) are key indicators of healthcare quality linked to improved outcomes. The Canadian Stroke Best Practice Recommendations emphasise the importance of capturing patient perceptions of health services to enhance clinical outcomes in stroke care. Building on our previously established stroke-specific PREM, this quality improvement (QI) observational project aimed to gather stroke patient experience data to identify strengths and opportunities for improvement.

Methods: This QI initiative was implemented in an acute stroke unit as part of the mobile transient ischaemic attack (TIA) and stroke with adaptive workflow project funded by Ontario's Ministry of Health. An interdisciplinary team of healthcare professionals and leadership members developed a survey focusing on patient journey themes. The survey was reviewed for readability and comprehension by two patients to ensure its appropriateness and relevance. The Institute for Healthcare Improvement model guided the initiative, with a project lead identifying eligible patients and a reactivation worker administering the surveys.

Results: A total of 110 patients with stroke or TIA completed the survey over a 12-month observational period. Positive experience rates ranged from 90.0% to 99.1% across all seven domains, and no respondent selected disagree or strongly disagree on any item. Discharge readiness was the lowest-rated domain (90%), whereas a coordinated transition to the stroke unit achieved the highest ratings (99.1%). Inductive thematic analysis of open-ended responses identified three themes: (1) overall satisfaction, gratitude and quality of care; (2) patient-centred communication and emotional support and (3) isolated concerns.

Conclusion: This QI initiative, building on previous work, showed positive patient experiences across all seven domains, with discharge readiness as a priority for improvement. The mixed-methods approach, which integrates quantitative Likert data with thematic analysis, offers a replicable model for patient-centred quality monitoring of stroke care.