How useful is an online tool to facilitate guideline implementation? Feasibility study of using eGLIA by stroke clinicians in Australia.

BACKGROUND: The success of guidelines is determined by their use in the real world. The GuideLine Implementability Appraisal (GLIA) tool was developed as a quality-improvement tool to assist guideline developers and guideline users identify potential problems in implementing recommendations. The objective of this study was to assess the feasibility of using the electronic version of GLIA (eGLIA) by implementers of a clinical guideline for acute stroke management in Australia. METHODS: Health professionals who had no previous experience with the eGLIA tool but who are involved in implementing guidelines volunteered for the study. These health professionals were provided background information about the tool and were provided a short training session (<30 min). The participants were asked to consider at least two recommendations from the guideline document. Time spent, numbers of recommendations reviewed and subjective feedback of the process were used for evaluation. RESULTS: 40 participants completed the study, representing nursing and allied health professions from different geographical regions of Australia. The median number of recommendations per participant completed was 2 (range 2-10), taking an average of 47 min (range 15-120 min) to complete or about 22 min per recommendation. Ninety-four per cent of participants agreed or strongly agreed that eGLIA was useful, while 77% indicated they would use the tool again. eGLIA helped participants think systematically about implementation, although only 72% agreed that the tool allowed them to clearly identify potential barriers to implementation. CONCLUSION: This study suggests that eGLIA may be a useful tool which is relatively easy to use for implementers of guidelines. eGLIA enables a detailed, systematic evaluation of guidelines. Further refinement of the tool is recommended to better assist implementers to clearly identify barriers to implementation and therefore facilitate greater implementation. Further work is also warranted to determine the effect of using eGLIA as part of an implementation strategy and if it improves health outcomes.

Access to stroke care units in Australian public hospitals: facts and temporal progress.

BACKGROUND: There is level I evidence that management of stroke patients in stroke units (SU) improves outcomes (death and institutionalization) by approximately 20%. In Australia, there is uncertainty as to the proportion of incident cases that have access to SU. Recent national and State-based policy initiatives to increase access to SU have been taken. However, objective evidence related to SU implementation progress is lacking. The aims of the study were (i) to determine the number of SU in Australian acute public hospitals in 2004, (ii) to describe hospitals according to national SU policy criteria and (iii) to compare results to the 1999 survey to track progress. METHODS: The method used in the study was a cross-sectional, postal survey technique. The participants were clinical representatives considered appropriate to describe stroke care within survey hospitals. RESULTS: The outcome of the study was presence of a SU according to an accepted definition. Response rate was 261/301 (87%). Sixty-one sites (23%) had either a SU and/or a dedicated stroke team. Fifty sites claimed to have a SU (19%). New South Wales with 23 had the most number of SU. Based on policy criteria, up to 64 sites could have a SU. In 1999, there were 35 public hospitals with a SU. CONCLUSION: Access to SU in Australian public hospitals remains low compared with other countries (Sweden, 70%). Implementation strategies supported by appropriate health policy to improve access are needed.