Influence of stroke coordinators on delivery of acute stroke care and hospital outcomes: An observational study

Abstract

Background Stroke coordinators have been inconsistently used in various countries to support stroke care in hospital. Aim To investigate the association between stroke coordinators and the provision of evidence-based care and patient outcomes in hospitals with acute stroke units. Methods Observational study using cross-sectional data from the 2015 National Acute Services Audit Program (Australia): including a retrospective medical record audit (40 records from each hospital) and a self-reported survey of organizational resources for stroke. Multilevel random effects logistic regression for patient outcomes including complications, independence on discharge, and death. Median regression for length of stay comparisons. Results A total of 109 hospitals submitted 4060 cases; 59 (54%) had a stroke coordinator. Compared with patients from stroke unit hospitals with no stroke coordinator ( N = 33, 1333 cases), patients in stroke unit hospitals with a stroke coordinator ( N = 53, 2072 cases) were more likely to receive clinical practices including rehabilitation therapy within 48 hours of initial assessment (88 vs. 82%, p < 0.001), risk factor modification advice (62 vs. 55%, p = 0.003) and receive a discharge care plan (65 vs. 48%, p < 0.001). No differences in complications, independence on discharge, or deaths were evident. Patients from hospitals with a stroke coordinator were more likely to access inpatient rehabilitation (adjusted odds ratio 1.8, 95% confidence interval 1.1-2.8) and have a reduced length of acute stay if discharged (median 14 h, p = 0.03). Conclusion Presence of stroke coordinators was associated with reduced length of stay and improved delivery of evidence-based care in hospitals with a stroke unit.

Provider-to-provider telemedicine improves adherence to sepsis bundle care in community emergency departments

“…12 Previous telemedicine pilot studies 12,13 have added a provider, nurse, or a quality specialist to the care of patients with sepsis, an approach that has been shown to be very effective in a variety of acute conditions, including sepsis. [27][28][29] The Surviving Sepsis Campaign has published multiple reports that dedicated quality improvement initiatives for sepsis patients are associated with improvements in guideline adherence and corresponding improvements in clinical outcomes. 24,30,31 While the benefit of these quality improvement initiatives is well supported, these practice changes have been challenging in low-volume rural hospitals.…”

Multidiscipline Stroke Post-Acute Care Transfer System: Propensity-Score-Based Comparison of Functional Status

“…To achieve a vertically integrated medical system, post-stroke care should be patient-centered, and inter-hospital transfer of stroke patients must be seamless. In Australia, stroke patients treated at hospitals with stroke coordinators had lower LOS and higher quality of evidence-based care compared to those treated at hospitals without stroke coordinators [28]. In the Taiwan national PAC project reported here, the case manager assigned to each stroke patient ensured efficient transfer of the patient to a local hospital.…”

Changes in acute hospital costs after employing clinical facilitators to improve stroke care in Victoria, Australia

“…Clinical facilitators are recognised as important for improving evidence-based practice as part of organisational redesign or achieving task oriented objectives [10, 11, 13, 21]. To our knowledge, we report for the first time on changes in acute hospital costs associated with investment in Facilitators employed to support improvements in the quality of acute stroke care at priority hospitals.…”