Cadilhac, DA and Andrew, NE and Stroil Salama, E and Hill, K and Middleton, S and Horton, E and Meade, I and Kuhle, S and Nelson, MR and Grimley, R, On behalf of the Australian Stroke Clinical Registry Consortium, Improving discharge care: The potential of a new organisational intervention to improve discharge after hospitalisation for acute stroke, a controlled before-after pilot study, BMJ Open, 7, (8) Article e016010. ISSN 2044-6055 (2017) [Refereed Article]
© Article author(s) 2017. Licensed under Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license (http://creativecommons.org/licenses/by-nc/4.0/)
Official URL: http://bmjopen.bmj.com/content/7/8/e016010
Setting: Acute care public hospitals in Queensland, Australia (n=15). The 15 hospitals were ranked against a benchmark based on a composite outcome of three discharge care processes. Clinicians from a 'top-ranked' hospital participated in a focus group to elicit their success factors. Two pilot hospitals then participated in the organisational intervention that was designed with experts and consumers.
Participants: Hospital clinicians involved in discharge care for stroke and patients admitted with acute stroke or transient ischaemic attack.
Intervention: A four-stage, multifaceted organisational intervention that included data reviews, education and facilitated action planning.
Primary and Secondary Outcome Measures: Three discharge processes collected in Queensland hospitals within the Australian Stroke Clinical Registry were used to select study hospitals: (1) discharge care plan; (2) antihypertensive medication prescription and (3) antiplatelet medication prescription (ischaemic events only). Primary measure: composite outcome. Secondary measures: individual adherence changes for each discharge process; sensitivity analyses. The performance outcomes were compared 3 months before the intervention (preintervention), 3 months postintervention and at 12 months (sustainability).
Results: Data from 1289 episodes of care from the two pilot hospitals were analysed. Improvements from preintervention adherence were: antiplatelet therapy (88%vs96%, p=0.02); antihypertensive prescription (61%vs79%, p<0.001); discharge planning (72%vs94%, p<0.001); composite outcome (73%vs89%, p<0.001). There was an insignificant decay effect over the 12-month sustainability period (composite outcome: 89% postintervention vs 85% sustainability period, p=0.08).
Conclusion: Discharge care in hospitals may be effectively improved and sustained through a staged and peer-informed, organisational intervention. The intervention warrants further application and trialling on a larger scale.
|Item Type:||Refereed Article|
|Keywords:||change management, clinical audit, quality in health care, stroke|
|Research Division:||Medical and Health Sciences|
|Research Group:||Cardiorespiratory Medicine and Haematology|
|Research Field:||Cardiology (incl. Cardiovascular Diseases)|
|Objective Group:||Clinical Health (Organs, Diseases and Abnormal Conditions)|
|Objective Field:||Cardiovascular System and Diseases|
|Author:||Nelson, MR (Professor Mark Nelson)|
|Web of Science® Times Cited:||1|
|Deposited By:||Menzies Institute for Medical Research|
|Downloads:||24 View Download Statistics|
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