Rather than hinder critical thinking, as many early warning systems' critics claim, nurses in this study found that the enhanced early warning system increased their awareness of changes in a patient's condition, resulting in earlier response and reassessment times. It also had an impact on the organization by improving communication and collaboration and supporting a culture of proactive rather than reactive response to early signs of deterioration.

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Background: Stroke patients have complex needs and are at high risk for complications, making transitional care critical to achieving improved outcomes. Although shared medical appointments (SMAs) are known to improve outcomes for other patient populations, evidence supporting SMA benefit for stroke patient transition from hospital to home is lacking. This study’s purpose was to examine feasibility of participation, patient satisfaction and understanding of key stroke topics following a transitional stroke SMA. Methods: Inclusion criteria for this study included: age 18 years or older, hospitalized for stroke/TIA, and planned discharge to home. Individuals with deficits impairing group participation were excluded. Eligible patients were educated on and invited to attend a SMA occurring 1-2weeks after hospital discharge. The SMA included a private exam and interactive group session to address key stroke topics: 1) medication compliance 2) individual risk factors, 3) secondary prevention, 4) signs of stroke and 5) actions for signs of stroke. Following the SMA, participants completed a two-part survey seeking a) a yes/no response to assess increased understanding of stroke topics, and b) level of agreement on satisfaction with the SMA format. Responses were analyzed using descriptive statistics. Results: While 15 patients agreed to participate prior to discharge, only eight attended the SMA. Attendees were primarily male (75%) with an ischemic stroke diagnosis (63%). The majority who did not attend were female (71%) and without family present during in-hospital education and invitation (86%). Age, stroke severity and stroke risk factors for both groups were otherwise similar. All participants reported an increased understanding of all stroke topics and 95% were satisfied with the SMA. Conclusion: Findings support use of SMAs for stroke patients transitioning from hospital to home. Reinforcing key stroke topics in a peer supported environment may increase understanding and compliance, leading to improved outcomes. Additional research is warranted to explore barriers to SMA participation.