scholarly journals A qualitative study of clinical champions in context: Clinical champions across three levels of acute care

2018 ◽  
Vol 6 ◽  
pp. 205031211879242 ◽  
Author(s):  
Mindy E Flanagan ◽  
Laurie Plue ◽  
Kristine K Miller ◽  
Arlene A Schmid ◽  
Laura Myers ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Acute Stroke ◽  
Stroke Care ◽  
Three Dimensions ◽  
Complex Care ◽  
Acute Stroke Care ◽  
Cross Sectional ◽  
Care Processes ◽  
Veterans Affairs Medical Centers ◽  
The Right

Objectives: To compare activities and field descriptions of clinical champions across three levels of stroke centers. Methods: A cross-sectional qualitative study using quota sampling was conducted. The setting for this study was 38 acute stroke centers based in US Veterans Affairs Medical Centers with 8 designated as Primary, 24 as Limited Hours, and 6 as Stroke Support Centers. Key informants involved in stroke care were interviewed using a semi-structured approach. A cross-case synthesis approach was used to conduct a qualitative analysis of clinical champions’ behaviors and characteristics. Clinical champion behaviors were described and categorized across three dimensions: enthusiasm, persistence, and involving the right people. Results: Clinical champions at Primary Stroke Centers represented diverse medical disciplines and departments (education, quality management); directed implementation of acute stroke care processes; coordinated processes across service lines; and benefited from supportive contexts for implementation. Clinical champions at Limited Hours Stroke Centers varied in steering implementation efforts, building collaboration across disciplines, and engaging in other clinical champion activities. Clinical champions at Stroke Support Centers were implementing limited changes to stroke care and exhibited few behaviors fitting the three clinical champion dimensions. Other clinical champion behaviors included educating colleagues, problem-solving, implementing new care pathways, monitoring progress, and standardizing processes. Conclusion: These data demonstrate clinical champion behaviors for implementing changes to complex care processes such as acute stroke care. Changes to complex care processes involved coordination among clinicians from multiple services lines, persistence facing obstacles to change, and enthusiasm for targeted practice changes.

Is the practice of goal-setting for patients in acute stroke care patient-centred and what factors influence this? A qualitative study

2015 ◽  
Vol 30 (5) ◽  
pp. 508-519 ◽  
Author(s):  
Sheeba Rosewilliam ◽  
Carron Sintler ◽  
Anand D Pandyan ◽  
John Skelton ◽  
Carolyn A Roskell
Keyword(s):  
Qualitative Study ◽  
Acute Stroke ◽  
Goal Setting ◽  
Stroke Care ◽  
Care Patient ◽  
Acute Stroke Care

scholarly journals A cross-sectional study of awareness regarding dog bite and its management in rural community of Maharashtra, India

2020 ◽  
Vol 7 (9) ◽  
pp. 1307
Author(s):  
Mohammed Alqwaifly
Keyword(s):  
Saudi Arabia ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Acute Stroke Care ◽  
Cross Sectional ◽  
Stroke Treatment

Background: Stroke is a major cause of morbidity and disability worldwide. However, its outcomes have improved in the last few years with advancement in acute stroke treatment, including the use of tissue plasminogen activator (t-PA) within 4.5 hours of onset, which led several international guidelines to adopt it as the standard of care. In this study, authors sought to assess the knowledge, practices, and attitudes of emergency and medicine staff in Qassim, Saudi Arabia toward acute ischemic stroke care.Methods: A quantitative observational cross-sectional study involving 148 physicians from emergency and medicine departments (only three neurologists) was conducted in three main hospitals of the Qassim region, Saudi Arabia. Information was obtained from a self-administered questionnaire. A logistic regression model was used to control for potential confounding factors.Results: Ninety-two percent of participants were aware of t-PA. Eighty-seven percent of participants thought that t-PA was an effective treatment for acute ischemic stroke. Only 20% of participants had given t-PA or participated in the use of t-PA in acute ischemic stroke. Moreover, 64% of participants believed that allowing blood pressure to remain high was the most appropriate action in the first 24 hours in acute ischemic stroke patients who presented outside the t-PA window.Conclusion: Most of the emergency and medicine staff are well informed about t-PA, but the majority of these physicians have never given t-PA or participated in the administration of t-PA to a stroke patient. The main finding here is the positive outlook among emergency and medicine physicians in Qassim toward training in acute stroke care and administering t-PA for stroke, which will positively impact patient outcomes.

scholarly journals Barriers to evidence-based acute stroke care in Ghana: a qualitative study on the perspectives of stroke care professionals

BMJ Open ◽  
2017 ◽  
Vol 7 (4) ◽  
pp. e015385 ◽  
Author(s):  
Leonard Baatiema ◽  
Ama de-Graft Aikins ◽  
Adem Sav ◽  
George Mnatzaganian ◽  
Carina K Y Chan ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Acute Stroke ◽  
Stroke Care ◽  
Evidence Based ◽  
Acute Stroke Care

scholarly journals Factors Associated with Shortening of Prehospital Delay among Patients with Acute Ischemic Stroke

2019 ◽  
Vol 8 (10) ◽  
pp. 1712 ◽  
Author(s):  
Raúl Soto-Cámara ◽  
Josefa González-Santos ◽  
Jerónimo González-Bernal ◽  
Asunción Martín-Santidrian ◽  
Esther Cubo ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Public Awareness ◽  
Stroke Care ◽  
University Hospital ◽  
Medical Emergency ◽  
Acute Stroke Care ◽  
Cross Sectional ◽  
Factors Associated ◽  
Prehospital Delay ◽  
Awareness Campaigns

Background: Despite recent advances in acute stroke care, only 1–8% of patients can receive reperfusion therapies, mainly because of prehospital delay (PHD). Objective: This study aimed to identify factors associated with PHD from the onset of acute stroke symptoms until arrival at the hospital. Methods: A cross-sectional study was conducted including all patients consecutively admitted with stroke symptoms to Burgos University Hospital (Burgos, Spain). Socio-demographic, clinical, behavioral, cognitive, and contextualized characteristics were recorded, and their possible associations with PHD were studied using univariate and multivariable regression analyses. Results: The median PHD of 322 patients was 138.50 min. The following factors decreased the PHD and time until reperfusion treatment where applicable: asking for help immediately after the onset of symptoms (OR 10.36; 95% confidence interval (CI) 4.47–23.99), onset of stroke during the daytime (OR 7.73; 95% CI 3.09–19.34) and the weekend (OR 2.64; 95% CI 1.19–5.85), occurrence of stroke outside the home (OR 7.09; 95% CI 1.97–25.55), using a prenotification system (OR 6.46; 95% CI 1.71–8.39), patient’s perception of being unable to control symptoms without assistance (OR 5.14; 95% CI 2.60–10.16), previous knowledge of stroke as a medical emergency (OR 3.20; 95% CI 1.38–7.40), call to emergency medical services as the first medical contact (OR 2.77; 95% CI 1.32–5.88), speech/language difficulties experienced by the patient (OR 2.21; 95% CI 1.16–4.36), and the identification of stroke symptoms by the patient (OR 1.98; 95% CI 1.03–3.82). Conclusions: The interval between the onset of symptoms and arrival at the hospital depends on certain contextual, cognitive, and behavioral factors, all of which should be considered when planning future public awareness campaigns.

scholarly journals Patient‐centredness in acute stroke care – a qualitative study from the perspectives of patients, relatives and staff

2020 ◽  
Vol 27 (8) ◽  
pp. 1638-1646
Author(s):  
L. Busetto ◽  
C. Stang ◽  
J. Hoffmann ◽  
H. Amiri ◽  
F. Seker ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Acute Stroke ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Patient Centredness

scholarly journals Health care providers’ perceptions of factors that influence the provision of acute stroke care in urban and rural settings: A qualitative study

2020 ◽  
Vol 8 ◽  
pp. 205031212092108
Author(s):  
Mitchell Dwyer ◽  
Gregory M. Peterson ◽  
Seana Gall ◽  
Karen Francis ◽  
Karen M. Ford
Keyword(s):  
Qualitative Study ◽  
Focus Groups ◽  
Acute Stroke ◽  
Stroke Care ◽  
Rural Hospitals ◽  
Public Hospitals ◽  
Barriers And Facilitators ◽  
Care Providers ◽  
Acute Stroke Care ◽  
Data Set

Objectives: Individuals living in rural areas have comparatively less access to acute stroke care than their urban counterparts. Understanding the local barriers and facilitators to the use of current best practice for acute stroke may inform efforts to reduce this disparity. Methods: A qualitative study featuring semi-structured interviews and focus groups was conducted in the Australian state of Tasmania. Clinical staff from a range of disciplines involved in acute stroke care were recruited from three of the state’s four major public hospitals (one urban and two rural). A semi-structured interview guide based on the findings of an earlier quantitative study was used to elicit discussion about the barriers and facilitators associated with providing acute stroke care. An inductive process of thematic analysis was then used to identify themes and subthemes across the data set. Results: Two focus groups and five individual interviews were conducted. Four major themes were identified from analysis of the data: systemic issues, clinician factors, additional support and patient-related factors. Acute stroke care within the study’s urban hospital was structured and comprehensive, aided by the hospital’s acute stroke unit and specialist nursing support. In contrast, care provided in the study’s rural hospitals was somewhat less comprehensive, and often constrained by an absence of infrastructure or poor access to existing resources. Conclusion: The identified factors help to characterise acute stroke care within urban and rural hospitals and will assist quality improvement efforts in Tasmania’s hospitals.

scholarly journals Humble But Powerful: The Role of “Access to Information & Knowledge” in Implementation Success in the RE-INSPIRE Study

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Colin M. E. Fry, M.S. ◽  
Edward J. Miech, PhD
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Access To Information ◽  
Veterans Health ◽  
Health Administration ◽  
Acute Stroke Care ◽  
High Stakes ◽  
Care Maps ◽  
Organizational Feature ◽  
The Right

Background and Hypothesis:  This study examines the role access to information and knowledge in acute stroke care following a 2011 stroke quality improvement clustered randomized trial and a national acute ischemic stroke (AIS) directive in the Veterans Health Administration.  Access to information is associated with the highest levels of acute stroke care provision, as well as other key organizational features.  Experimental Design or Project Methods:  A multidisciplinary team analyzed and conducted semistructured interviews of clinical providers across 11 VAMCs over a 3-year period.  The interviews were then coded and analyzed using a mix methods approach. This study focused on the “Access to Information and Knowledge” organization feature defined in the Consolidated Framework for Implementation Research constructs.  Results:  The manifestations of this organizational feature include: stroke binders, intranet share-points, pocket cards, algorithms, checklists, templates, stroke kits, flow sheets, care maps, posters, and room signs.  Acute stroke is a low-volume, high stakes, time sensitive condition at these sites. Therefore, proper access to information is especially important to ensure a continuity of care that transcends the idiosyncrasies of individual providers allowing for quick, correct, and complete care of the patient.  Conclusion and Potential Impact:  The mere presence of certain tools in a clinical setting is not enough, but rather the feature relies on getting the right information, to the right people, at the right time.  Access to information exemplifies the need for implementation science, and insights from this study can be broadly applied to a plethora of scenarios in other clinical settings.

scholarly journals Patients’ and carers’ experiences of gaining access to acute stroke care: a qualitative study: Table 1

2012 ◽  
Vol 30 (12) ◽  
pp. 1033-1037 ◽  
Author(s):  
Madeleine Harrison ◽  
Tony Ryan ◽  
Clare Gardiner ◽  
Amanda Jones
Keyword(s):  
Qualitative Study ◽  
Acute Stroke ◽  
Stroke Care ◽  
Acute Stroke Care
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