Improvements in the quality of care and health outcomes with new stroke care units following implementation of a clinician-led, health system redesign programme in New South Wales, Australia

Cadilhac, Dominique A.; Pearce, Dora C; Levi, Christopher; Donnan, Geoffrey A.

doi:10.1136/qshc.2007.024604

Cited by 54 publications

(69 citation statements)

References 18 publications

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“…Although it is difficult to make direct comparisons, these findings are consistent with stroke service redesign programs in metropolitan hospitals. 1 Although establishing a hub and spoke model of care was also an important component of the RSP, describing the effect of this model on clinical process indicators was not a primary aim of this article.…”

Section: Discussionmentioning

confidence: 99%

“…The NSW Stroke Audit tool 1,8 was developed in 2002 and predates clinical guidelines for stroke, which were first released for Australia in 2003. Nevertheless, the audit tool did cover the majority of recommendations outlined in these guidelines.…”

Section: Data Collectionmentioning

confidence: 99%

“…1,17 Even considering the potential lack of resources, infrastructure, and specialist personnel in rural settings, there is some suggestive evidence that implementing service improvement initiatives, such as peer support and use of protocols, in rural areas can improve the quality of stroke care. 18,19 However, it is still unclear whether introducing elements of organized stroke care, such as clinical coordinators and SUs, within rural settings can reduce evidence-practice gaps as found with metropolitan hospitals.…”

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confidence: 99%

“…Inconsistent access to evidence-based interventions, such as stroke units (SUs), has been shown to have detrimental effects on patient outcomes. 1,2 Being able to provide evidence-based stroke care consistently remains a challenge, particularly in rural locations. 3 This is because rural hospitals are less likely to offer coordinated and dedicated services for stroke care in comparison with metropolitan hospitals.…”

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confidence: 99%

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Evaluation of Rural Stroke Services

Cadilhac

Purvis

Kilkenny

et al. 2013

Stroke

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Furthermore, only 4% to 5% of the 91 rural hospitals that responded to a national survey had an SU or access to neurologists, <50% used a care pathway, and only 32% had a clinical nurse specialist for stroke.3 With ≈7 million residents, New South Wales (NSW) is the most populated state in Australia, 9 and almost a third of this population live in rural areas.11 Similar to many locations, variability in the provisionBackground 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.

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Section: Discussionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Evaluation of Rural Stroke Services

Cadilhac

Purvis

Kilkenny

et al. 2013

Stroke

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“…4,5 However, the impact of a dedicated CICU on patient outcomes following congenital surgery has not been evaluated to date. Several adult and pediatric studies [6][7][8][9][10][11][12][13] support the notion that the cohorting of patients with certain conditions, and specialized care or use of standardized treatment protocols, may improve outcomes. The purpose of this study was to evaluate postoperative outcomes associated with a dedicated CICU versus other ICU care models in a multi-institutional population undergoing congenital heart surgery.…”

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confidence: 99%