Innovation in Stroke Care Quality: NIH Stroke Scale Change and Shewhart Charts

Michael R. Dobbs, Prashanth Krishnamohan, Gregory Jicha, Amy P. Cohen

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Stroke care, admission through discharge, is a process that should lead to symptomatic improvement. Improvement or decline in conditions of patients with acute stroke during hospitalization can be measured by the National Institutes of Health Stroke Scale (NIH Stroke Scale or NIHSS) at both admission and discharge and may indicate the overall quality of acute stroke care for a patient and the stability of care in the system. Shewhart control charts were analyzed for 98 patients with stroke admissions in a random sample at a tertiary care stroke center to determine the feasibility of examining the NIHSS score change to detect statistical control or identify excess variance in outcomes. The study sample showed a mean improvement of 1.33 points from admission to discharge on the NIHSS. Three statistical outliers were found. Excess statistical variation clustered within a specific stroke team's tenure suggested a need for targeted education and examination for process redesign. Using the NIHSS and the Shewhart control charts identified a systematic process flaw that could be targeted to improve stroke outcomes and move the delivery system toward statistical control.

Original languageEnglish
Pages (from-to)135-139
Number of pages5
JournalQuality Management in Health Care
Issue number3
StatePublished - Jul 30 2015

Bibliographical note

Publisher Copyright:
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


  • NIH Stroke Scale
  • Shewhart chart
  • quality control

ASJC Scopus subject areas

  • Leadership and Management
  • Health(social science)
  • Health Policy
  • Care Planning


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