None listed
Conditions
Brief summary
Stroke is the most common cause of complex disability for adults (Adamson, et al. 2004) and there is strong evidence that implementation of stroke clinical practice guidelines will improve the quality and effectiveness of the health care received by patients following a stroke (Donnellan, et al, 2013). Despite this, there is wide variation in the quality of stroke care provided by different health organisations (Lindsay, et al. 2011). Clinical practice guidelines are documents that integrate current evidence on how to most effectively structure and provide health services for a given condition (Weisz, et al. 2007). They can inform health care decision making for the patient, clinician and the health service. They can also inform an evaluation of the health care sevice (Gagliardi, et al. 2015). In March 2014, Cabrini appointed a stroke service steering committee with the aim of enhancing care to Cabrini stroke patients to a level that is consistent with the (Australian) National Stroke Foundation's (NSF) 'Clinical Guidelines for Stroke Management' (Bodice, et al. 2010.) The NSF's Acute Stroke Services Framework (2011) recommends all hospitals admitting 100 or more patients with stroke per year should be a primary stroke centre (PSC). Cabrini has patient numbers admitted that are consistent with this criterion and therefore has aimed to provide a PSC service for our patients. The NSF defines a PSC as having a dedicated sroke unit with clinicians who have stroke expertise; written stroke protocols for emergency services, acute care and rehabilitation; ability to offer thrombolytic therapy or protocols to transfer appropriate patients to a comprehensive stroke centre; timely neurovascular imaging and coordinated processes for patient transition to ongoing rehabilitation and secondary prevention services. It is the transition from the previous non-specific model of care for patients admitted to Cabrini following a stroke, to the current evidence-based practice, which is central to the current evaluation. This follows the implementation at Cabrini of the Clinical Guidelines for Stroke Management between September 2014 and July 2015. The broader project shall complete a comprehensive medical history audit to investigate how well Cabrini performs against the Clinical Guidelines for stroke Management, including patient clinical outcomes, before and after the implementation of the Clinical Guidelines for Stroke Management.
Interventions
The intervention is the implementation of the Stroke CG's as per the Cabrini policies, procedures and guidelines in line with the Stroke CG's from the National Stroke Foundation (NSF). Implementation commenced in September 2014 and was completed in June 2015.
Hospital staff did not receive a specific education package relating to the implementation of the guidelines, although they were notified via multiple modes of communication that the guidelines (in the form of updated hospital policies)
The intervention is the implementation of the Stroke CG's as per the Cabrini policies, procedures and guidelines in line with the Stroke CG's from the National Stroke Foundation (NSF). Implementation commenced in September 2014 and was completed in June 2015. Hospital staff did not receive a specific education package relating to the implementation of the guidelines, although they were notified via multiple modes of communication that the guidelines (in the form of updated hospital policies) should be followed as of September 2014. The modes of communication include the hospital bulletin (email and hard copy), announcement in management communication forum as well as announcement and discussion in hospital department meetings. Key measurable elements of the Stroke CG's include: Admitted to a stroke unit, Brain imaging within 24 hours, Received intravenous thrombolysis if ischaemic stroke, Aspirin within 48 hours if ischaemic stroke, Assessed by physiotherapy within 48 hours, Assessed by Speech pathologist within 48 hours, Swallow screened before given food, drink or oral medication, Assessment results and treatment plans discussed with patient, Discharged on antihypertensives and Documented discharge plan. Each health professional shall use physical and informational materials that are usually available to them. For example, the stroke care coordinator shall provide the "My Journey" information and personal reflection diary to the patient post stroke. This is available from the National Stroke Foundation. This is not new information, but provision of this information is consistent for all patients post stroke. The intervention is broadly generic to all patients post stroke, that is the Stroke CG's, but there will be individual variation pending on the health professionals assessment. As intervention adherence is a primary aim of this study, this shall be measured via patient medical record audit against a number of criteria that reflect the Stroke CG's. Adherence shall be compared between the pre and post implementation time periods, as well as againt the National benchmarks (data provided by the National Stroke Foundation).
Sponsors
Dr Natasha Brusco
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Educational / counselling / training
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients admitted to Cabrini with a diagnosis of a stroke prior to the implementation of Stroke Clinical Guidelines (pre intervention group), and patients admitted to Cabrini after the implementation of Stroke Clinical Guidelines (post intervention group). Patients are adults admitted to Cabrini with either a primary or secondary diagnosis of stroke. A primary diagnosis of stroke indicates that a diagnosis of a new stroke was the primary reason for admission to Cabrini. A secondary diagnosis of stroke typically indicates that the patient was admitted to Cabrini with another unrelated diagnosis and has had a diagnosis of a new stroke during the hospital admission.
Exclusion criteria
Patients are excluded if they are admitted to a hospital that is not Cabrini. Any patient who has not had an ischaemic or haemorrhagic stroke within the dedicated retrospective and prospective time frames is excluded from the trial. Note that a past medical history of stroke is not a secondary diagnosis of stroke. Only the first 100 retrospective patients (working in reverse chronological order) and 100 prospective patients (working in chronological order) are evaluated. Patients who fall outside of said time frames and patient number will be excluded.
Outcome results
None listed