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Background and Aim Performance assessment of the Stroke Pathway is a key element in healthcare quality. The aim of this study has been to carry out a retrospective assessment of the Stroke Pathway in a first level Stroke Unit in Italy, analyzing the temporal trend of the Stroke Pathway performance and the impact of the COVID-19 pandemic. Methods A retrospective observational study was carried out analyzing data from 1/01/2010 to 31/12/2020. The following parameters were considered: volume and characteristics of patients with ischemic stroke undergoing intravenous thrombolysis, baseline modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) scores, Onset-to-Door (OTD), Door-To-Imaging (DTI) and Door-To-Needle (DTN) Times, mRS score 3 months after the ischemic event onset (3 m-mRS) and NIHSS score 24 h after the ischemic event onset (24 h-NIHSS). The study also compared the pre-COVID-19 pandemic period (March-December 2019) with the one immediately following it (March-December 2020). Results 418 patients were included. Over time, treatment was extended to older patients (mean age from 66.3 to 75.51 years; p = 0.006 ) and with a higher level of baseline disability (baseline mRS score from 0.22 to 1.22; p = 0.000 ). A statistically significant reduction over the years was found for DTN, going from 90 min to 61 min ( p = 0.000 ) with also an increase in the number of thrombolysis performed within the “golden hour” – more than 50% in 2019 and more of 60% in 2020. Comparing pre- and during COVID-19 pandemic periods, the number of patients remained almost unchanged, but with a significantly higher baseline disability (mRS = 1.18 vs. 0.72, p = 0.048 ). The pre-hospital process indicator OTD increased from 88.13 to 118.48 min, although without a statistically significant difference (p = 0.197). Despite the difficulties for hospitals due to pandemic, the hospital process indicators DTI and DTN remained substantially unchanged, as well as the clinical outcome indicators 3 m-mRS, NHISS and 24 h-NHISS. Conclusions The results of the retrospective assessment of the Stroke Pathway highlighted its positive impact both on hospital processes and patients’ outcomes, even during the COVID-19 pandemic, so that the current performance is aligning itself with international goals. Moreover, the analysis showed the need of improvement actions for both hospital and pre-hospital phases. The Stroke Pathway should be improved with the thrombolysis starting in the diagnostic imaging department in order to further reduce the DTN score. Moreover, health education initiatives involving all the stakeholders should be promoted, also by using social media, to increase population awareness on timely recognition of stroke signs and symptoms and emergence medical services usage.

Background Hospitals can gain valuable insights into their current level of organizational health literacy (OHL) by using self-assessment tools. OHL self-assessment tools can serve as useful instruments for supporting the planning and implementation of OHL interventions aimed at promoting health equity and improving patient outcomes. This explorative study aimed to pilot the International Self-Assessment Tool for Organizational Health Literacy (Responsiveness) of Hospitals (OHL-Hos) among hospitals across six countries. Methods The OHL-Hos, grounded in a comprehensive theoretical framework consisting of eight standards, 21 sub-standards and 141 indicators, was piloted in seven hospitals: one in Austria, Germany, the Czech Republic, Norway and Serbia, and two in Italy. In each hospital, the feasibility of using the OHL-Hos was investigated regarding acceptability, implementation, practicality, and integration, identifying strengths and areas for improvement using descriptive analyses. The self-assessment process included individual rating of an interdisciplinary and inter-hierarchical assessment team regarding OHL-Hos indicators from their personal perspectives, followed by a joint assessment to reach a consensus on different ratings. The process and experiences were documented in semi-structured forms, while the ratings on the indicators were documented numerically. Results All hospitals successfully self-assessed their OHL, identifying strengths and areas for improvement. The self-assessment process varied slightly among countries. While the tool was considered important but lengthy and complex, introductory workshops facilitated successful implementation. The self-assessment process raised awareness and stimulated discussions on improving OHL, highlighting the tool’s potential for organizational development. Conclusions The OHL-Hos can serve as a useful tool to identify strengths and areas for improvement in OHL in hospitals. The overall experience with the tool was positive and the joint assessment with the tool was found to foster consensus and enable reflection on OHL, but its comprehensive nature poses challenges to its implementation, leading to recommendations for developing a shortened version of the tool with simple language. Certain indicators require specific knowledge, suggesting different professional groups should address relevant parts.

Influenza is an important public health issue given its significant burden of disease. In Italy, the unsatisfactory coverage rate in people ≥65 years underlines the need to improve the current vaccination pathway. This study aims to define an integrated pathway across primary and secondary care, facilitated by a digital clinical decision support system (CDSS), to enhance vaccination coverage in people ≥65 years by actively recruiting patients in hospitals and administering vaccination. Moreover, the study seeks to gauge the potential epidemiological and economic impact of this approach. The methodology consisted of two main phases: definition of the integrated pathway and CDSS and estimation of the potential epidemiological and economic impact resulting from the implementation of the pathway in the whole Lazio region. Assuming an increase of influenza vaccination coverage from the current rate of 60% to 65% in ≥65 years old population in the Lazio region thanks to the pathway implementation, an increase of 8% in avoided influenza cases, avoided influenza- or pneumonia-related hospitalizations and avoided influenza-related outpatient visits was estimated with a relative increase in savings for hospitalizations and outpatient visits of up to 11.85%. Setting the vaccination coverage at 70%, the impact is doubled. Alongside offering a predictive estimate of the pathway’s potential impact, both epidemiological and economic, this project, with its robust methodology, may serve as a scalable and transferable model for enhancing vaccination coverage at national and international level.