The scope for improvement in hyper-acute stroke care in Scotland

Jacobson, Evin Uzun; Bayer, Steffen; Barlow, James; Dennis, Martin; MacLeod, Mary Joan

doi:10.1016/j.orhc.2015.09.003

Cited by 8 publications

(5 citation statements)

References 22 publications

(20 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Bagi penderita kecacatan berdampak terhadap kehilangan waktu produktif, kemandirian, identitas, kehidupan sosial bahkan dapat menurunkan kualitas hidup yang pada akhirnya mengakibatkan pengaruh yang sangat besar secara psikologis, diikuti stress dan depresi (Aly et al, 2009;Bray, 2011). Bagi keluarga akan menanggung mahalnya biaya perawatan langsung maupun tidak langsung akibat stroke sehingga akan meningkatkan beban penyakit, sosial maupun ekonomi keluarga (Jacobson, Bayer, Barlow, Dennis, & MacLeod, 2015;Yperzeele et al, 2014).…”

Section: Pendahuluanunclassified

Waktu Kedatangan Pasien Post Serangan Ke Instalasi Gawat Darurat Dengan Outcome Pasien Stroke Iskemik Akut

Muhlis¹

2021

j. Keperawatan Tropis Papua

View full text Add to dashboard Cite

Keberhasilan tindakan dan peningkatan outcome pada stroke sangat bergantung pada kecepatan pasien dibawa ke instalasi gawat darurat namun sebagian besar pasien stroke iskemik akut datang terlambat ke instalasi gawat darurat. Tujuan penelitian ini adalah untuk mengetahui hubungan waktu kedatangan pasien post serangan stroke iskemik akut dengan outcome pasien stroke iskemik akut di Rumah Sakit dr. H. Chasan Boesoirie di Kota Ternate. Desain penelitian menggunakan analitik observasional dengan pendekatan cross-sectional study. Penelitian ini dilaksanakan di Rumah Sakit dr. H. Chasan Boesoirie di Kota Ternate, Maluku Utara. Sampel penelitian sebanyak 104 pasien stroke iskemik akut di instalasi gawat darurat yang dipilih menggunakan teknik total sampling. Analisis data menggunakan uji statistik Spearman rank correlation test dengan tingkat signifikan sebesar α= 0,05. Hasil analisis Spearman rank correlation test menunjukkan bahwa terdapat hubungan yang signifikan antara waktu kedatangan post serangan stroke iskemik akut ke instalasi gawat darurat (p=0,027) dengan outcome pasien stroke iskemik akut dan koefisien korelasi sebesar (r) = 0,217. Terdapat hubungan yang signifikan antara waktu kedatangan post serangan stroke iskemik akut ke instalasi gawat darurat dengan outcome pasien stroke iskemik akut di Rumah Sakit dr. H. Chasan Boesoirie di Kota Ternate.

show abstract

Section: Pendahuluanunclassified

Waktu Kedatangan Pasien Post Serangan Ke Instalasi Gawat Darurat Dengan Outcome Pasien Stroke Iskemik Akut

Muhlis¹

2021

j. Keperawatan Tropis Papua

View full text Add to dashboard Cite

show abstract

“…As an example of the interaction between outcome factor and scope, Barone et al, [15] considered departmental scope in relation to time, resource and cost outcome factors through simulation to plan daily nurse requirements in a stroke unit. In contrast, Uzun Jacobson et al, [186] considered a clinical scope in relation to patient progression outcomes, through discreteevent simulation of hyper-acute stroke care, concerning the percentage of patients receiving thrombolysis. -Strategic planning involves structural decision making of the design, dimensioning and development of healthcare.…”

Section: Outcomementioning

confidence: 99%

“…Obtained Data Driven [5, 7-9, 11, 13, 32, 33, 37, 47-49, 54, 58, 62, 66, 70-72, 74-76, 80, 81, 83, 85-99, 104, 107, 108, 112, 120, 121, 124, 126, 127, 131, 133, 134, 138-140, 143, 144, 147-150, 153, 157, 160, 162, 167, 170, 172, 177-179, 183-185, 191, 192, 195, 197-206, 209-211] Collaboration [3,10,14,17,27,42,51,73,100,114,142,152,163] Both [12,20,35,40,56,101,103,129,136,146,154,166,171,186] Other [19,21,22,24,41,60,79,82,116,128,169] Table A6. Care level considered.…”

Section: Fundingmentioning

confidence: 99%

“…Investigating Type Mapping (Ma) [1, 4, 5, 7, 22, 29, 33, 37, 42, 47, 48, 54, 56, 57, 70, 71, 81, 83, 87, 88, 90, 91, 94-99, 104, 112, 121, 126, 127, 131, 136, 138, 139, 144, 149, 154, 157, 161, 162, 164, 170, 172, 177-179, 183-185, 192, 195, 197-203, 206, 209-211] Modelling (Mo) [15, 19-21, 23, 24, 30, 31, 36, 39, 43, 50, 55, 58, 64, 67, 76, 79, 82, 86, 89, 102, 103, 115, 117-119, 122, 129, 145-147, 150, 151, 160, 169, 171, 187, 188, 190, 191, 196, 212] Improving (I) [13,46] Ma & Mo [3, 9, 11, 17, 18, 40, 60, 62, 66, 72-74, 80, 85, 90, 93, 101, 107, 108, 114, 120, 124, 125, 128, 133, 134, 140, 143, 158, 205] Mo & I [8,16,25,32,34,41,45,52,53,68,75,110,111,113,116,141,148,165,182] All Types [10,12,14,27,35,49,51,100,142,152,153,163,166,167,186,204] Table A12. Outcome focus of the pathway.…”

Section: Fundingmentioning

confidence: 99%

See 1 more Smart Citation

Clinical pathway modelling: a literature review

2019

View full text Add to dashboard Cite

Hospital information systems are increasingly used as part of decision support tools for planning at strategic, tactical and operational decision levels. Clinical pathways are an effective and efficient approach in standardising the progression of treatment, to support patient care and facilitate clinical decision making. This literature review proposes a taxonomy of problems related to clinical pathways and explores the intersection between Information Systems (IS), Operational Research (OR) and industrial engineering. A structured search identified 175 papers included in the taxonomy and analysed in this review. The findings suggest that future work should consider industrial engineering integrated with OR techniques, with an aim to improving the handling of multiple scopes within one model, while encouraging interaction between the disjoint care levels and with a more direct focus on patient outcomes. Achieving this would continue to bridge the gap between OR, IS and industrial engineering, for clinical pathways to aid decision support.

show abstract

“…Further, simulation allows complex healthcare systems with stochastic elements, such as stroke pathways, to be replicated to provide insights and recommendations for improvements. Discrete-event simulation has been shown to be an effective approach applied to pre-hospital (16,17), intra-hospital (18)(19)(20)(21), and both pre and intra-hospital aspects of the acute stroke pathways (22)(23)(24)(25)(26)(27)(28)(29). Discrete-event simulation literature also spans to areas such as operation of a stroke unit (30), the impact of additional comprehensive stroke centers for EVT (31), and AIS patient disability post-hospital (32).…”

Section: Introductionmentioning

confidence: 99%

Discrete-Event Simulation to Model the Thrombolysis Process for Acute Ischemic Stroke Patients at Urban and Rural Hospitals

2021

View full text Add to dashboard Cite

Background: Effective treatment with tissue plasminogen activator (tPA) critically relies on rapid treatment. Door-to-needle time (DNT) is a key measure of hospital efficiency linked to patient outcomes. Numerous changes can reduce DNT, but they are difficult to trial and implement. Discrete-event simulation (DES) provides a way to model and determine the impact of process improvements.Methods: A conceptual framework was developed to illustrate the thrombolysis process; allowing for treatment processes to be replicated using a DES model developed in ARENA. Activity time duration distributions from three sites (one urban and two rural) were used. Five scenarios, three process changes, and two reductions in activity durations, were simulated and tested. Scenarios were tested individually and in combinations. The primary outcome measure is median DNT. The study goal is to determine the largest improvement in DNT at each site.Results: Administration of tPA in the imaging area resulted in the largest median DNT reduction for Site 1 and Site 2 for individual test scenarios (12.6%, 95% CI 12.4–12.8%, and 8.2%, 95% CI 7.5–9.0%, respectively). Ensuring that patients arriving via emergency medical services (EMS) remain on the EMS stretcher to imaging resulted in the largest median DNT improvement for Site 3 (9.2%, 95% CI 7.9–10.5%). Reducing both the treatment decision time and tPA preparation time by 35% resulted in a 11.0% (95% CI 10.0–12.0%) maximum reduction in median DNT. The lowest median and 90th percentile DNTs were achieved by combining all test scenarios, with a maximum reduction of 26.7% (95% CI 24.5–28.9%) and 17.1% (95% CI 12.5–21.7%), respectively.Conclusions: The detailed conceptual framework clarifies the intra-hospital logistics of the thrombolysis process. The most significant median DNT improvement at rural hospitals resulted from ensuring patients arriving via EMS remain on the EMS stretcher to imaging, while urban sites benefit more from administering tPA in the imaging area. Reducing the durations of activities on the critical path will provide further DNT improvements. Significant DNT improvements are achievable in urban and rural settings by combining process changes with reducing activity durations.

show abstract

The scope for improvement in hyper-acute stroke care in Scotland

Cited by 8 publications

References 22 publications

Waktu Kedatangan Pasien Post Serangan Ke Instalasi Gawat Darurat Dengan Outcome Pasien Stroke Iskemik Akut

Waktu Kedatangan Pasien Post Serangan Ke Instalasi Gawat Darurat Dengan Outcome Pasien Stroke Iskemik Akut

Clinical pathway modelling: a literature review

Discrete-Event Simulation to Model the Thrombolysis Process for Acute Ischemic Stroke Patients at Urban and Rural Hospitals

Contact Info

Product

Resources

About