Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part II: Rehabilitation

Dysphagia ◽  
2021 ◽  
Author(s):  
Ebru Umay ◽  
Sibel Eyigor ◽  
Cumhur Ertekin ◽  
Zeliha Unlu ◽  
Barin Selcuk ◽  
...  
Author(s):  
Joshua Biro ◽  
David M. Neyens ◽  
Candace Jaruzel ◽  
Catherine D. Tobin ◽  
Myrtede Alfred ◽  
...  

Medication errors and error-related scenarios in anesthesia remain an important area of research. Interventions and best practice recommendations in anesthesia are often based in the work-as-imagined healthcare system, remaining under-used due to a range of unforeseen complexities in healthcare work-as- done. In order to design adaptable anesthesia medication delivery systems, a better understanding of clinical cognition within the context of anesthesia work is needed. Fourteen interviews probing anesthesia providers’ decision making were performed. The results revealed three overarching themes: (1) anesthesia providers find cases challenging when they have incomplete information, (2) decision-making begins with information seeking, and (3) attributes such as expertise, experience, and work environment influence anesthesia providers’ information seeking and synthesis of tasks. These themes and the context within this data help create a more realistic view of work-as-done and generate insights into what potential medication error reducing interventions should look to avoid and what they could help facilitate.


Author(s):  
David J. Gladstone ◽  
M. Patrice Lindsay ◽  
James Douketis ◽  
Eric E Smith ◽  
Dar Dowlatshahi ◽  
...  

Author(s):  
Elizabeth M. Perpetua ◽  
Kimberly A. Guibone ◽  
Patricia A. Keegan ◽  
Roseanne Palmer ◽  
Martina K. Speight ◽  
...  

2008 ◽  
Vol 178 (11) ◽  
pp. 1418-1425 ◽  
Author(s):  
P. Lindsay ◽  
M. Bayley ◽  
A. McDonald ◽  
I. D. Graham ◽  
G. Warner ◽  
...  

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Shelley Sharp ◽  
Elizabeth Linkewich ◽  
Jacqueline Willems ◽  
Nicola Tahair ◽  
Charissa Levy ◽  
...  

Background: A regional Stroke Report Card identified poor performance on system efficiency, effectiveness, and integration of stroke best practice. This engaged regional funders and 17 organizations (11 acute, 6 rehab) to collaborate in stroke system planning. The focus included stroke unit care and access to timely and appropriate rehabilitation, including increased access for severe stroke. Changes in acute care, including pre-hospital, have facilitated access to stroke unit care in the city. A model of patient flow from acute care was needed to understand other system capacity needs. Purpose: To use best practice and benchmarks to delineate post-acute patient flow and facilitate alignment of resources for inpatient rehabilitation. Methods: Administrative data from national reporting and local rehab referral system databases were used to review current system usage from acute care. A model of proportional distribution of cases from acute, specifically to inpatient rehab, was established using provincial benchmarks, evidence informed targets, and organization market share of total inpatient rehab system capacity. Iterative discussions were required to confirm the organizations’ commitment to stroke best practice. New volume and case mix changes were applied to determine capacity and resource planning needs across organizations. Results: The best practice model, approved by all stakeholders, proposes 40% of stroke patients discharged alive from acute care should access inpatient, 13% outpatient rehabilitation and 6% to Complex Continuing Care and Long Term Care. Current practice is 26%, <5% and 13% respectively. A projected volume increase of 278 patients is distributed across 5/6 rehab providers. This results in a total proportional system shift from 20% (n=160) to 41.5% (n =446) of severe patients receiving access to high intensity rehab. A reduction in the overall proportion of moderate and mild stroke patients from 65% (519) to 49.5% (n=534) and 15% (n=119) to 9% (n=96) respectively. Conclusion: Significant investment/redistribution of resources within the system is required to support patient flow and provide care in the right place at the right time. System funder support is critical to create a quality of care (best practice) system.


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