Improving stroke clinical guideline adherence in an Australian hospital using a clinician-led implementation process.
Top Stroke Rehabil
; 30(7): 738-750, 2023 10.
Article
en En
| MEDLINE
| ID: mdl-36323526
ABSTRACT
BACKGROUND:
Private hospitals in Australia manage 11% of acute and 48% of rehabilitation stroke admissions, yet little is known about implementation of stroke clinical guidelines in this setting. Clinical guidelines recommend that acute stroke patients be co-located in a stroke unit in a geographically defined area, rather than dispersed across the hospital.OBJECTIVE:
To investigate post-intervention adherence to clinical guidelines for stroke management, and to explore staff barriers and facilitators to guideline implementation.METHODS:
Observational study before-and-after local implementation of Australian stroke clinical guidelines. The primary outcome was a change in the proportion of patients who were physically co-located in an acute stroke unit. Secondary outcomes included changes in adherence to additional acute and rehabilitation guideline criteria, and staff identification of barriers and facilitators to guide implementation. Data were collected from medical record audits, health service information and staff surveys.RESULTS:
Co-location in an acute stroke unit did not change significantly after guideline implementation (49% adherence pre-intervention and 54% post-intervention). Across acute and rehabilitation wards, 15% (11/72) of guideline criteria improved (p < .05). These related to assessments of swallowing and neglect, presence of a stroke care co-ordinator and occupational therapist, post-discharge care plan, provision of patient education and return to driving. Facilitators to guideline implementation included staff education, collaboration, and dissemination of user-friendly stroke policies.CONCLUSION:
Stroke clinical guideline implementation led to a favorable uptake of some criteria, yet not all. Implementation was assisted by staff education, user-friendly stroke policies and multidisciplinary team collaboration. TRIAL REGISTRATION ANZCTR registration number ACTRN12616000646448 (http//www.ANZCTR.org.au/ACTRN12616000646448.aspx).Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Accidente Cerebrovascular
Tipo de estudio:
Guideline
/
Observational_studies
/
Prognostic_studies
/
Qualitative_research
Límite:
Humans
País/Región como asunto:
Oceania
Idioma:
En
Revista:
Top Stroke Rehabil
Asunto de la revista:
ANGIOLOGIA
/
REABILITACAO
Año:
2023
Tipo del documento:
Article
País de afiliación:
Australia