Background and purpose Although patient‐centredness is considered a key component of high‐quality neurological care, it is unclear to what extent it can or should be implemented during the acute phase. Using acute stroke as an example, the aim was to identify critical junctures for patient‐centredness along the acute care pathway from the perspectives of patients, relatives and staff. Methods A qualitative multi‐method study was conducted including 27 non‐participant observations and 37 semi‐structured interviews with patients, relatives and staff. Junctures were defined as critical when mentioned (as problematic) in two or three information sources (i.e. observations, staff interviews, or patient and relative interviews), as potentially critical when mentioned in one, and as uncritical when not mentioned. Results Post‐procedure communication after thrombectomy, patients’ stay at the stroke unit and decision‐making around transfer, discharge and rehabilitation were identified as critical junctures for patient‐centredness. Arrival at the emergency department and the (thrombectomy) treatment itself were identified as uncritical junctures, whilst history‐taking and treatment preparation, the treatment decision and patients’ stay at the intensive care unit were identified as potentially critical junctures. Conclusions In acute stroke care, patients, relatives and staff prioritize fast over patient‐centred decision‐making in the most time‐critical phases, especially before and during treatment. This is reversed after the procedure, when difficulties arise implementing a patient‐centred approach in clinical practice. To improve patient‐centredness where it is most needed, clear guidelines and accessible resources are recommended. Future research should investigate whether insights from acute phases of stroke care are applicable to other neurological conditions as well.

Background Telemedical services can be used to complement on‐site services when demand for specialists exceeds supply or when specialists are not evenly distributed across health systems. Using stroke as an example, this study aimed to explore how patients and staff experience telestroke cooperation in a stroke network in Germany. Methods We conducted a qualitative multi‐method and multi‐centre study combining 32 non‐participant observations at one hub and four spoke hospitals with 26 semi‐structured interviews with hub and spoke staff as well as stroke patients and relatives. Observation protocols and interview transcripts were analysed to identify barriers and facilitators to telestroke cooperation from the perspectives of staff, patients and relatives. Results In terms of barriers to telestroke cooperation, we found technological problems, providing the treatment for one patient from two sites, competing priorities between telestroke and in‐house duties in the spoke hospitals, as well as difficulties in participating in the teleneurological examination via a videoconferencing system for older and disabled patients. In terms of facilitators, we found an overall very positive perception of telestroke provision by patients, good professional relationships within the network, and sharing of neurological expertise to be experienced as helpful for telestroke cooperation. Conclusions We recommend better integration of telemedical services into the care pathway, fostering relationships within the network, improved technological support and resources, and more emphasis within networks, in public awareness efforts as well as in academia on the evaluation of telemedical services from the perspectives of patients and relatives, especially older patients and patients with disabilities.

Introduction:Patients experiencing acute ischemic stroke should access treatment as soon as possible to increase their chances for survival without severe disability. Given the increased complexity of stroke treatment from the provider and patient perspective, this study provides an overview of the pathways followed by stroke patients during in-hospital treatment.Methods: This qualitative study combined twenty-seven observations and fifteen staff interviews at a German comprehensive stroke center providing endovascular treatment ("EVT hospital"). Analysis was based on the COMIC Model for the comprehensive evaluation of complex health care interventions and a grounded theory approach. Results:The patient pathways during in-hospital treatment span the phases (1) admission to hospital, (2) receiving recanalization therapies, and (3) in-patient treatment. Before admission to the EVT hospital, interactions between staff members from the EVT hospital and patients take place as part of the telestroke consultations during which the EVT hospital's ED neurologist meets the patient via a video-and audio-based connection. During the second phase, when IVT and/or EVT are provided to the patient, three teams (ED, neuroradiology and ICU team) with direct patient interactions intersect at the angiography suite until mechanical recanalisation treatment ends and the patient is transferred to the SU or ICU. In the third phase, the patients are treated on the SU or ICU and staff members interact with them according to a pre-defined schedule as well as based on individual needs. Discussion: Our results show that most direct staff-patient interactions are focussed within one phase, with a smaller number of interactions extending to other phases, and no professional (group) with direct patient interactions cover more than two phases of the acute stroke pathway. Future research should investigate how the pathways described here are experienced from the patient perspective, including how the organisation of visible care processes may influence patient satisfaction. Findings can be translated to accessible patient information resources as well as input for digitalisation efforts, provider orientation and training.