Hospital organizational context and delivery of evidence-based stroke care: a cross-sectional study

Abstract

BackgroundOrganizational context is one factor influencing the translation of evidence into practice, but data pertaining to patients with acute stroke are limited. We aimed to determine the associations of organizational context in relation to four important evidence-based stroke care processes.MethodsThis was a mixed methods cross-sectional study. Among 19 hospitals in Queensland, Australia, a survey was conducted of the perceptions of stroke clinicians about their work using the Alberta Context Tool (ACT), a validated measure covering 10 concepts of organizational context, and with additional stroke-specific contextual questions. These data were linked to the Australian Stroke Clinical Registry (AuSCR) to determine the relationship with receipt of evidence-based acute stroke care (acute stroke unit admission, use of thrombolysis for those with acute ischemic stroke, receipt of a written care plan on discharge, and prescription of antihypertensive medications on discharge) using quantile regression. Exploratory cluster analysis was used to categorize hospitals into high and low context groups based on all of the 10 ACT concepts. Differences in adherence to care processes between the two groups were examined.ResultsA total of 215 clinicians completed the survey (50% nurses, 37% allied health staff, 10% medical practitioners), with 81% being in their current role for at least 1 year. There was good reliability (∞ 0.83) within the cohort to allow pooling of professional groups. Greater ACT scores, especially for social capital (μ 9.00, 95% confidence interval [CI] 4.86 to 13.14) and culture (μ 7.33, 95% CI 2.05 to 12.62), were associated with more patients receiving stroke unit care. There was no correlation between ACT concepts and other care processes. Working within higher compared to lower context environments was associated with greater proportions of patients receiving stroke unit care (88.5% vs. 69.0%) and being prescribed antihypertensive medication at discharge (62.5% vs. 52.0%). Staff from higher context hospitals were more likely to value medical and/or nursing leadership and stroke care protocols.ConclusionsOverall organizational context, and in particular aspects of culture and social capital, are associated with the delivery of some components of evidence-based stroke care, offering insights into potential pathways for improving the implementation of proven therapies.Electronic supplementary materialThe online version of this article (10.1186/s13012-018-0849-z) contains supplementary material, which is available to authorized users.

Value, knowledge and implementation on evidence‐based practice among nurse managers in china: A regional cross‐sectional survey

“…Organisational culture has repeatedly been identified as an important factor influencing EBP (Andrew et al, ). Our study results demonstrated that EBP organisational culture and readiness were the strongest factors of the total Quick‐EBP‐VIK score.…”

Measuring organizational context in Australian emergency departments and its impact on stroke care and patient outcomes

“…The ACT draws on the Promoting Action on Research Implementation in Health Services framework that considers context, evidence, and facilitation as the three key concepts for research implementation (Kitson, Harvey, & McCormack, 1998;McCormack et al, 2002;Rycroft-Malone, 2004). It has been primarily applied in Canadian long-term care (Estabrooks et al, 2015;Knopp-Sihota, Niehaus, Squires, Norton, & Estabrooks, 2015;Slaughter & Estabrooks, 2013) and pediatric hospital settings (Squires et al, 2013;Yamada, Squires, Estabrooks, Victor, & Stevens, 2017) with individual studies conducted in Europe (Eldh, Ehrenberg, Squires, Estabrooks, & Wallin, 2013;F€ orberg et al, 2014;Hoben, Estabrooks, Squires, & Behrens, 2016;Seers et al, 2018) and Australia (Andrew et al, 2019;Schultz & Kitson, 2010).…”

“…A qualitative study of clinicians' perspectives on barriers and facilitators to implementing rehabilitation guidelines for patients with stroke found that time and resources were important contextual factors that affected guideline implementation (Munce et al, 2017). In a cross-sectional study of 19 Australian hospitals it was identified that working in higher compared to lower context environments (measured using the ACT) was associated with improved stroke care (Andrew et al, 2019). An analysis of 36 Canadian nursing homes showed that facilities with higher context scores (assessed using the ACT) had a significantly lower prevalence of dyspnoea, pain, and urinary tract infections in nursing home residents (Estabrooks et al, 2015).…”

“…Further, evidence of associations between nurse or hospital characteristics and ED organizational context is scarce with none of the prior studies conducted exclusively in ED. A comprehensive understanding of the context in which a practice-change intervention is to be implemented may help to identify potentially modifiable factors that can be addressed before intervention implementation and/or help to explain circumstances that may have impeded practice change (Andrew et al, 2019;Seers et al, 2018).…”

Correction to: Hospital organizational context and delivery of evidence-based stroke care: a cross-sectional study

“…Following publication of the original article [1], the authors reported an error in one of the authors’ names. In this Correction the incorrect and correct author name are shown.…”