Abstract 267: Improving Inpatient Stroke Care by Implementing Stroke Units Across Health Systems Using an Improvement Collaborative Approach
Notice bibliographique
Résumé
Background: Stroke units, defined as a geographic location where stroke patients are cared for by an interdisciplinary team, hold the strongest evidence in reduced mortality and disability for stroke patients. However, according to the 2011 Canadian Stroke Network’s National Stroke Audit, only 23% of stroke patients in Canada were admitted to a Stroke Unit with the Canadian province of British Columbia (BC) lagging at only 4%. The objective of this quality improvement initiative was to increase the number of stroke units and to improve existing stroke units; additionally, we aimed to improve adherence to best practice acute stroke care. Methods: Using the Institute for Healthcare Improvement’s Breakthrough Series Collaborative methodology, a stroke unit Improvement Collaborative was run from January 2013 to December 2013 by Stroke Services BC, a program of the Provincial Health Services Authority in BC. Faculty members were recruited from BC and the Calgary Stroke Program in the province of Alberta. The collaborative had 4 Learning Sessions, a closing workshop, and bi-weekly webinars. Teams followed a structured 7-step framework: understanding current volumes; securing space; establishing the team; ensuring clinical best practice; creating processes for team communication; ensuring patient engagement; and establishing quality improvement mechanisms. Pre and post self-reports of care were collected through electronic polling at Learning Session 2 in February 2013 (pre, n=78) and at the Closing Celebration in December 2013 (post, n=66) using a 4-point Likert scale. There were 20 questions based on best practice. Results: Eleven teams enrolled representing 17 hospitals in BC and a hospital in Saskatoon in the province of Saskatchewan. Teams were either working at the hospital or health region level. There were a total of 75 new stroke beds created in BC, and 12 beds recommended for Saskatoon. Furthermore, the results from the e-voting on best practice showed statistically significant improvement in the following areas: admission to a stroke unit (p=0.005); assessment by an interdisciplinary team within 48 hours of admission (p=0.002); use of standardized valid tools (p=0.002); swallowing screen within 24 hours (p<0.001); core interprofessional team on the stroke unit (p<0.001); care to prevent secondary complication (p<0.001); management of serum lipid levels (p=0.017); patient education (p<0.001); and team education (p=0.02). Conclusions: This inter-provincial Quality Improvement Collaborative was successful in implementing and improving stroke units, and in improving best practice care of inpatient stroke patients. Critical success factors include the engagement of faculty from high-performing centers even if they exist outside the jurisdiction where improvement is sought, and the use of the 7-step framework for implementing stroke units.
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Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
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