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Improving stroke care in Nova Scotia, Canada: a population-based project spanning 14 years

Stroke is a complex disorder that challenges healthcare systems. An audit of in-hospital stroke care in the province of Nova Scotia, Canada, in 2004–2005 indicated that many aspects of care delivery fell short of national best practice recommendations. Stroke care in Nova Scotia was reorganised usin...

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Autores principales: Phillips, Stephen James, Stevens, Allison, Cao, Huiling, Simpkin, Wendy, Payne, Jennifer, Gill, Neala
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8475131/
https://www.ncbi.nlm.nih.gov/pubmed/34561278
http://dx.doi.org/10.1136/bmjoq-2021-001368
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author Phillips, Stephen James
Stevens, Allison
Cao, Huiling
Simpkin, Wendy
Payne, Jennifer
Gill, Neala
author_facet Phillips, Stephen James
Stevens, Allison
Cao, Huiling
Simpkin, Wendy
Payne, Jennifer
Gill, Neala
author_sort Phillips, Stephen James
collection PubMed
description Stroke is a complex disorder that challenges healthcare systems. An audit of in-hospital stroke care in the province of Nova Scotia, Canada, in 2004–2005 indicated that many aspects of care delivery fell short of national best practice recommendations. Stroke care in Nova Scotia was reorganised using a combination of interventions to facilitate systems change and quality improvement. The focus was mainly on implementing evidence-based stroke unit care, augmenting thrombolytic therapy and enhancing dysphagia assessment. Key were the development of a provincial network to facilitate ongoing collaboration and structured information exchange, the creation of the stroke coordinator and stroke physician champion roles, and the implementation of a registry to capture information about adults hospitalised because of stroke or transient ischaemic attack. To evaluate the interventions, a longitudinal analysis compared the audit results with registry data for 2012, 2015 and 2019. The proportion of patients receiving multidisciplinary stroke unit care rose from 22.4% in 2005 to 74.0% in 2019. The proportion of patients who received alteplase increased steadily from 3.2% to 18.5%, and the median delay between hospital arrival and alteplase administration decreased from 102 min to 56 min, without an increase in intracranial haemorrhage. Dysphagia screening increased from 41.4% to 77.4%. More patients were transferred from acute care to a dedicated in-patient rehabilitation unit, and fewer were discharged to residential or long-term care. These enhancements did not prolong length-of-stay in acute care. The network was a critical success factor; competing priorities in the healthcare system were the main challenge to implementing change. A multidimensional, multiyear, improvement intervention yielded substantial and sustained improvements in the process and structure of stroke care in Nova Scotia.
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spelling pubmed-84751312021-10-08 Improving stroke care in Nova Scotia, Canada: a population-based project spanning 14 years Phillips, Stephen James Stevens, Allison Cao, Huiling Simpkin, Wendy Payne, Jennifer Gill, Neala BMJ Open Qual Quality Improvement Report Stroke is a complex disorder that challenges healthcare systems. An audit of in-hospital stroke care in the province of Nova Scotia, Canada, in 2004–2005 indicated that many aspects of care delivery fell short of national best practice recommendations. Stroke care in Nova Scotia was reorganised using a combination of interventions to facilitate systems change and quality improvement. The focus was mainly on implementing evidence-based stroke unit care, augmenting thrombolytic therapy and enhancing dysphagia assessment. Key were the development of a provincial network to facilitate ongoing collaboration and structured information exchange, the creation of the stroke coordinator and stroke physician champion roles, and the implementation of a registry to capture information about adults hospitalised because of stroke or transient ischaemic attack. To evaluate the interventions, a longitudinal analysis compared the audit results with registry data for 2012, 2015 and 2019. The proportion of patients receiving multidisciplinary stroke unit care rose from 22.4% in 2005 to 74.0% in 2019. The proportion of patients who received alteplase increased steadily from 3.2% to 18.5%, and the median delay between hospital arrival and alteplase administration decreased from 102 min to 56 min, without an increase in intracranial haemorrhage. Dysphagia screening increased from 41.4% to 77.4%. More patients were transferred from acute care to a dedicated in-patient rehabilitation unit, and fewer were discharged to residential or long-term care. These enhancements did not prolong length-of-stay in acute care. The network was a critical success factor; competing priorities in the healthcare system were the main challenge to implementing change. A multidimensional, multiyear, improvement intervention yielded substantial and sustained improvements in the process and structure of stroke care in Nova Scotia. BMJ Publishing Group 2021-09-24 /pmc/articles/PMC8475131/ /pubmed/34561278 http://dx.doi.org/10.1136/bmjoq-2021-001368 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Quality Improvement Report
Phillips, Stephen James
Stevens, Allison
Cao, Huiling
Simpkin, Wendy
Payne, Jennifer
Gill, Neala
Improving stroke care in Nova Scotia, Canada: a population-based project spanning 14 years
title Improving stroke care in Nova Scotia, Canada: a population-based project spanning 14 years
title_full Improving stroke care in Nova Scotia, Canada: a population-based project spanning 14 years
title_fullStr Improving stroke care in Nova Scotia, Canada: a population-based project spanning 14 years
title_full_unstemmed Improving stroke care in Nova Scotia, Canada: a population-based project spanning 14 years
title_short Improving stroke care in Nova Scotia, Canada: a population-based project spanning 14 years
title_sort improving stroke care in nova scotia, canada: a population-based project spanning 14 years
topic Quality Improvement Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8475131/
https://www.ncbi.nlm.nih.gov/pubmed/34561278
http://dx.doi.org/10.1136/bmjoq-2021-001368
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