scholarly journals Evaluation of Rural Stroke Services

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2848-2853 ◽  
Author(s):  
Dominique A. Cadilhac ◽  
Tara Purvis ◽  
Monique F. Kilkenny ◽  
Mark Longworth ◽  
Katherine Mohr ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Rural Areas ◽  
Stroke Care ◽  
Stroke Units ◽  
Care Plans ◽  
Cohort Design ◽  
South Wales ◽  
Health Assessments ◽  
Multivariable Analyses

Background and Purpose— The quality of hospital care for stroke varies, particularly in rural areas. In 2007, funding to improve stroke care became available as part of the Rural Stroke Project (RSP) in New South Wales (Australia). The RSP included the employment of clinical coordinators to establish stroke units or pathways and protocols, and more clinical staff. We aimed to describe the effectiveness of RSP in improving stroke care and patient outcomes. Methods— A historical control cohort design was used. Clinical practice and outcomes at 8 hospitals were compared using 2 medical record reviews of 100 consecutive ischemic or intracerebral hemorrhage patients ≥12 months before RSP and 3 to 6 months after RSP was implemented. Descriptive statistics and multivariable analyses of patient outcomes are presented. Results— Sample: pre-RSP n=750; mean age 74 (SD, 13) years; women 50% and post-RSP n=730; mean age 74 (SD, 13) years; women 46%. Many improvements in stroke care were found after RSP: access to stroke units (pre 0%; post 58%, P <0.001); use of aspirin within 24 hours of ischemic stroke (pre 59%; post 71%, P <0.001); use of care plans (pre 15%; post 63%, P <0.001); and allied health assessments within 48 hours (pre 65%; post 82% P <0.001). After implementation of the RSP, patients directly admitted to an RSP hospital were 89% more likely to be discharged home (adjusted odds ratio, 1.89; 95% confidence interval, 1.34–2.66). Conclusions— Investment in clinical coordinators who implemented organizational change, together with increased clinician resources, effectively improved stroke care in rural hospitals, resulting in more patients being discharged home.

scholarly journals Effects of centralizing acute stroke services

Neurology ◽  
2018 ◽  
Vol 91 (3) ◽  
pp. e236-e248 ◽  
Author(s):  
Sidsel Hastrup ◽  
Soren P. Johnsen ◽  
Thorkild Terkelsen ◽  
Heidi H. Hundborg ◽  
Paul von Weitzel-Mudersbach ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Acute Stroke ◽  
Stroke Care ◽  
Acute Hospital ◽  
Acute Stroke Care ◽  
Difference In Differences ◽  
Stroke Units ◽  
Before And After ◽  
Stroke Services

ObjectiveTo investigate the effects of centralizing the acute stroke services in the Central Denmark Region (CDR).MethodsThe CDR (1.3 million inhabitants) centralized acute stroke care from 6 to 2 designated acute stroke units with 7-day outpatient clinics. We performed a prospective “before-and-after” cohort study comparing all strokes from the CDR with strokes in the rest of Denmark to discover underlying general trends, adopting a difference-in-differences approach. The population comprised 22,141 stroke cases hospitalized from May 2011 to April 2012 and May 2013 to April 2014.ResultsCentralization was associated with a significant reduction in length of acute hospital stay from a median of 5 to 2 days with a length-of-stay ratio of 0.53 (95% confidence interval 0.38–0.75, data adjusted) with no corresponding change seen in the rest of Denmark. Similarly, centralization led to a significant increase in strokes with same-day admission (mainly outpatients), whereas this remained unchanged in the rest of Denmark. We observed a significant improvement in quality of care captured in 11 process performance measures in both the CDR and the rest of Denmark. Centralization was associated with a nonsignificant increase in thrombolysis rate. We observed a slight increase in readmissions at day 30, but this was not significantly different from the general trend. Mortality at days 30 and 365 remained unchanged, as in the rest of Denmark.ConclusionsCentralizing acute stroke care in the CDR significantly reduced the length of acute hospital stay without compromising quality. Readmissions and mortality stayed comparable to the rest of Denmark.

scholarly journals Stroke Care in Pakistan

2021 ◽  
pp. 118-121
Author(s):  
Anjum Farooq ◽  
Narayanaswamy Venketasubramanian ◽  
Mohammad Wasay
Keyword(s):  
Acute Stroke ◽  
Plasminogen Activator ◽  
Rural Areas ◽  
Recombinant Tissue Plasminogen Activator ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Stroke Units ◽  
Stroke Outcomes ◽  
Tissue Plasminogen ◽  
Urban And Rural Areas

Increasing incidence of stroke and lack of infrastructure in both urban and rural areas needs immediate attention in Pakistan. There is a high proportion of young stroke with poor stroke outcomes. Acute stroke care is scarce in Pakistan due to the small number of neurologists (1 neurologist per 1 million population), few stroke units, and limited availability of alteplase (recombinant tissue plasminogen activator) in the country.

scholarly journals Temporal variations in quality of acute stroke care and outcomes in London hyperacute stroke units: a mixed-methods study

2020 ◽  
Vol 8 (34) ◽  
pp. 1-98
Author(s):  
Robert Simister ◽  
Georgia B Black ◽  
Mariya Melnychuk ◽  
Angus IG Ramsay ◽  
Abigail Baim-Lance ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Acute Stroke ◽  
Stroke Care ◽  
National Audit ◽  
Acute Stroke Care ◽  
Stroke Units ◽  
Hyperacute Stroke ◽  
Factors Influencing ◽  
Time Of Admission

Background Seven-day working in hospitals is a current priority of international health research and policy. Previous research has shown variability in delivering evidence-based clinical interventions across different times of the day and week. We aimed to identify factors influencing such variations in London hyperacute stroke units. Objectives To investigate variations in quality of acute stroke care and outcomes by day and time of admission in London hyperacute stroke units, and to identify factors influencing such variations. Design This was a prospective cohort study using anonymised patient-level data from the Sentinel Stroke National Audit Programme. Factors influencing variations in care and outcomes were studied through interview and observation data. Setting The setting was acute stroke services in London hyperacute stroke units. Participants A total of 7094 patients with a primary diagnosis of stroke took part. We interviewed hyperacute stroke unit staff (n = 76), including doctors, nurses, therapists and administrators, and 31 patients and carers. We also conducted non-participant observations of delivery of care at different times of the day and week (n = 45, ≈102 hours). Intervention Hub-and-spoke model for care of suspected acute stroke patients in London with performance standards was designed to deliver uniform access to high-quality hyperacute stroke unit care across the week. Main outcome measures Indicators of quality of acute stroke care, mortality at 3 days after admission, disability at the end of the inpatient spell and length of stay. Data sources Sentinel Stroke National Audit Programme data for all patients in London hyperacute stroke units with a primary diagnosis of stroke between 1 January and 31 December 2014, and nurse staffing data for all eight London hyperacute stroke units for the same period. Results We found no variation in quality of care by day and time of admission across the week in terms of stroke nursing assessment, brain scanning and thrombolysis in London hyperacute stroke units, nor in 3-day mortality nor disability at hospital discharge. Other quality-of-care measures significantly varied by day and time of admission. Quality of care was better if the nurse in charge was at a higher band and/or there were more nurses on duty. Staff deliver ‘front-door’ interventions consistently by taking on additional responsibilities out of hours, creating continuities between day and night, building trusting relationships and prioritising ‘front-door’ interventions. Limitations We were unable to measure long-term outcomes as our request to the Sentinel Stroke National Audit Programme, the Healthcare Quality Improvement Partnership and NHS Digital for Sentinel Stroke National Audit Programme data linked with patient mortality status was not fulfilled. Conclusions Organisational factors influence 24 hours a day, 7 days a week (24/7), provision of stroke care, creating temporal patterns of provision reflected in patient outcomes, including mortality, length of stay and functional independence. Future work Further research would help to explore 24/7 stroke systems in other contexts. We need a clearer understanding of variations by looking at absolute time intervals, rather than achievement of targets. Research is needed with longer-term mortality and modified Rankin Scale data, and a more meaningful range of outcomes. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 34. See the NIHR Journals Library website for further project information.

scholarly journals Variation in quality of acute stroke care by day and time of admission: prospective cohort study of weekday and weekend centralised hyperacute stroke unit care and non-centralised services

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e025366 ◽  
Author(s):  
Mariya Melnychuk ◽  
Stephen Morris ◽  
Georgia Black ◽  
Angus I G Ramsay ◽  
Jeannie Eng ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Unit ◽  
Performance Standards ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
P Values ◽  
Stroke Units ◽  
Hyperacute Stroke ◽  
Time Of Admission

ObjectiveTo investigate variations in quality of acute stroke care and outcomes by day and time of admission in London hyperacute stroke units compared with the rest of England.DesignProspective cohort study using anonymised patient-level data from the Sentinel Stroke National Audit Programme.SettingAcute stroke services in London hyperacute stroke units and the rest of England.Participants68 239 patients with a primary diagnosis of stroke admitted between January and December 2014.InterventionsHub-and-spoke model for care of suspected acute stroke patients in London with performance standards designed to deliver uniform access to high-quality hyperacute stroke unit care across the week.Main outcome measures16 indicators of quality of acute stroke care, mortality at 3 days after admission to the hospital, disability at the end of the inpatient spell, length of stay.ResultsThere was no variation in quality of care by day and time of admission to the hospital across the week in terms of stroke nursing assessment, brain scanning and thrombolysis in London hyperacute stroke units, nor was there variation in 3-day mortality or disability at hospital discharge (all p values>0.05). Other quality of care measures significantly varied by day and time of admission across the week in London (all p values<0.01). In the rest of England there was variation in all measures by day and time of admission across the week (all p values<0.01), except for mortality at 3 days (p value>0.05).ConclusionsThe London hyperacute stroke unit model achieved performance standards for ‘front door’ stroke care across the week. The same benefits were not achieved by other models of care in the rest of England. There was no weekend effect for mortality in London or the rest of the England. Other aspects of care were not constant across the week in London hyperacute stroke units, indicating some performance standards were perceived to be more important than others.

The best Laid Plans?: Obstacles to the Implementation of Plans for Children

2008 ◽  
Vol 32 (4) ◽  
pp. 31-41 ◽  
Author(s):  
Gareth Roach ◽  
Robert Sanders
Keyword(s):  
Child Protection ◽  
Contextual Information ◽  
Care Plan ◽  
Plan Implementation ◽  
Care Plans ◽  
Analysis Methodology ◽  
Looked After Children ◽  
South Wales ◽  
Decision Making Processes

Gareth Roach and Robert Sanders describe a study of the obstacles to the implementation of plans for children in a South Wales local authority. The files of 20 children, selected sequentially, were examined using a content analysis methodology. Ten were children in need of protection living at home with their families and ten were looked after children. Information was extracted from child protection plans, core group meetings, care plans and care plan reviews, along with important contextual information. Implementation was assessed by identifying and monitoring the progress of delayed tasks through the different stages of the child's planning and reviewing process. This provided a detailed understanding of the decision-making processes and the reason(s) for tasks becoming delayed. The results indicated that most cases experienced some delay. The main obstacles to plan implementation centred on the quality of the plans and reviews, a lack of interagency co-ordination in the provision of external services and the non-compliance of parents and carers. To address these problems and reduce the likelihood of delay, the authors suggest that social workers should incorporate micro-planning techniques into practice, attempt to engage parents and carers fully, and improve recording procedures.

scholarly journals Stroke care networks and the impact on quality of care

2021 ◽  
Author(s):  
Jan Schoenfelder ◽  
Mansour Zarrin ◽  
Remo Griesbaum ◽  
Ansgar Berlis
Keyword(s):  
Network Design ◽  
Rural Areas ◽  
Stroke Care ◽  
Treatment Method ◽  
Stroke Units ◽  
Levels Of Care ◽  
Improvement Potential ◽  
Current Design ◽  
The Impact ◽  
Travel Distances

AbstractLack of rapidly available neurological expertise, especially in rural areas, is one of the key obstacles in stroke care. Stroke care networks attempt to address this challenge by connecting hospitals with specialized stroke centers, stroke units, and hospitals of lower levels of care. While the benefits of stroke care networks are well-documented, travel distances are likely to increase when patients are transferred almost exclusively between members of the same network. This is particularly important for patients who require mechanical thrombectomy, an increasingly employed treatment method that requires equipment and expertise available in specialized stroke centers. This study aims to analyze the performance of the current design of stroke care networks in Bavaria, Germany, and to evaluate the improvement potential when the networks are redesigned to minimize travel distances. To this end, we define three fundamental criteria for assessing network design performance: 1) average travel distances, 2) the populace in the catchment area relative to the number of stroke units, and 3) the ratio of stroke units to lower-care hospitals. We generate several alternative stroke network designs using an analytical approach based on mathematical programming and clustering. Finally, we evaluate the performance of the existing networks in Bavaria via simulation. The results show that the current network design could be significantly improved concerning the average travel distances. Moreover, the existing networks are unnecessarily imbalanced when it comes to their number of stroke units per capita and the ratio of stroke units to lower-care hospitals.

Telemedicine-enabled ambulances and mobile stroke units for prehospital stroke management

2021 ◽  
pp. 1357633X2110477
Author(s):  
Stephen W English ◽  
Kevin M Barrett ◽  
Willam D Freeman ◽  
Bart M Demaerschalk
Keyword(s):  
Emergency Medical Services ◽  
Patient Outcomes ◽  
Stroke Unit ◽  
Stroke Care ◽  
Growth Potential ◽  
Stroke Management ◽  
Stroke Units ◽  
Unit Model ◽  
Mobile Stroke Unit ◽  
Improve Patient

The recognition and management of stroke in the prehospital setting has become increasingly important to improve patient outcomes. Several strategies to advance prehospital stroke care have been developed, including the mobile stroke unit and the telemedicine-enabled ambulance—or “mini-MSU.” These strategies both incorporate ambulance-based audio-visual telemedicine evaluation with a vascular neurologist to facilitate faster treatment but differ in several areas including upfront and recurring costs, scalability or growth potential, ability to integrate into existing emergency medical services systems, and interoperability across multiple specialties or conditions. While both the mobile stroke unit and mini-mobile stroke unit model are valid approaches to improve stroke care, the authors aim to compare these models based on costs, scalability, integration, and interoperability in order to guide our prehospital leaders to find the best solutions for their communities.

Community-based stroke system of care improves patient outcomes in Chinese rural areas

2018 ◽  
Vol 72 (7) ◽  
pp. 630-635 ◽  
Author(s):  
Mingli He ◽  
Jin’e Wang ◽  
Qing Dong ◽  
Niu Ji ◽  
Pin Meng ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Rural Areas ◽  
Stroke Care ◽  
System Of Care ◽  
Community Based ◽  
Stroke Incidence ◽  
Disability Rate ◽  
Registration Number ◽  
Care Systems ◽  
Educational Campaign

BackgroundBuilding effective and efficient stroke care systems is a key step in improving prevention, treatment and rehabilitation of stroke. The aim of this study was to evaluate the effectiveness of this stroke system of care on stroke management during a 2-year follow-up.MethodsA stroke system of care was developed from November 2009 to November 2010 in three townships in Ganyu County. Additional three matched townships were invited as controls. We first investigated the stroke incidence of these populations. Subsequently, this stroke system of care and an educational campaign in the three intervention townships were implemented and the effectiveness of the system was evaluated in the next 2 years.ResultsAt postintervention, more patients in the intervention communities obtained stroke knowledge and then the proportion of patients with stroke who were admitted within 3 hours of onset markedly increased in 2012 (12.0% vs 8.1%, p=0.044) and in 2013 (15.2% vs 9.7%, p=0.008) compared with those in the control communities. In the intervention communities, this proportion of patients with acute ischaemic stroke who received thrombolytic treatment was markedly raised from 2.1% in 2012 to 3.0% in 2013. More importantly, the fatality rate substantially decreased in 2013 in the intervention communities compared with that in the control communities (6.1% vs 9.7%, p=0.032). Similarly, the disability rate significantly decreased in 2013 (45.3% vs 51.5%, p=0.045).ConclusionsThe community-based stroke system of care was effective and practical for optimising stroke treatments and improving patient outcomes.Trial registration numberChiCTR-RCH-13003408, Post-results.

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