Impact of the NIHSS scale in the Stroke Unit of the Ramón y Cajal University Hospital: A tool to improve the quality of care

Abstract

Introduction

Stroke is a time-dependent pathology which requires a rapid and universal neurological assessment tool. Since October 2021, following training of nursing staff, the NIHSS scale has been implemented in order to increase comparability, concordance and improve communication with the medical team.

Objectives

1. To examine the concordance among scores of the NIHSS scale implemented by nursing staff and medical team in Neurology Service of the Ramón y Cajal Hospital. 2. To describe the subjective perception of using the NIHSS scale from the nursing staff in the Neurology Service of the Ramón y Cajal Hospital.

Method

Cross-sectional observational study that included 100 patients distributed in two periods of three months each in the Stroke Unit of the Ramón y Cajal Hospital. The NIHSS scale scores given by nursing and neurology were collected, as well as the discordant items of each assessment. Statistical analyzes included frequencies, percentages, Cronbach's alpha and the Intraclass Correlation Coefficient. A survey was conducted among the 22 professionals to assess the degree of acceptance.

Results

A high concordance (68% and 70% in each period) was achieved between the nursing and neurology. A total of 94% of professionals reported to get used to the NIHSS scale.

Conclusions

The implementation of the NIHSS scale is a clear opportunity for improvement in the stroke unit, facilitating communication between nursing and neurology teams, due to agreement between scores and increasing quality of medical care.