Effects of care pathways on stroke care practices at regional hospitals

Read, S. J. and Levy, J. (2006) Effects of care pathways on stroke care practices at regional hospitals. Internal Medicine Journal, 36 10: 638-642. doi:10.1111/j.1445-5994.2006.01147.x

Author Read, S. J.
Levy, J.
Title Effects of care pathways on stroke care practices at regional hospitals
Journal name Internal Medicine Journal   Check publisher's open access policy
ISSN 1444-0903
Publication date 2006-01-01
Sub-type Article (original research)
DOI 10.1111/j.1445-5994.2006.01147.x
Open Access Status Not Open Access
Volume 36
Issue 10
Start page 638
End page 642
Total pages 5
Editor J. Szer
Place of publication Carlton South, Australia
Publisher Blackwell Publishing Asia
Language eng
Subject C1
321013 Neurology and Neuromuscular Diseases
730104 Nervous system and disorders
Abstract Background: Our previous work identified deficiencies in stroke care practices at regional hospitals in comparison to standards suggested by published stroke care guidelines. These deficiencies might be improved by the implementation of clinical pathways. The aim of this study was to assess changes in acute stroke care practices following the implementation of stroke care pathways at four regional Queensland hospitals. Methods: The medical records of two cohorts of 120 patients with a discharge diagnosis of stroke or transient ischaemic attack were retrospectively audited before and after implementation of stroke care pathways to identify differences in the use of acute interventions, investigations and secondary prevention strategies. Results: Following pathway implementation there were clinically important, but not statistically significant, increases in the rates of swallow assessment, allied health assessment (significant for occupational therapy, P = 0.04) and use of deep vein thrombosis prevention strategies (also significant, P = 0.006). Fewer patients were discharged on no anti-thrombotic therapy (statistically significant in the subgroup of patients with atrial fibrillation, P = 0.02). Only 37% of the patients audited were actually enrolled on the pathway. Among this subgroup there were significant increases in the rates of swallow assessment (first 24 h, P = 0.01; any time during admission, P = 0.0001), allied health assessments (all P < 0.05), estimation of blood glucose level (P = 0.0015) and the use of deep vein thrombosis prevention strategies (P = 0.0003). Conclusion: Stroke care pathways appear to improve the process of care. Whether this influences outcomes such as mortality, functional and neurological recovery, the incidence of complications, length of stay or the cost of care was beyond the scope of this study and will require further examination.
Keyword Medicine, General & Internal
Acute Stroke
Stroke Units
Process Assessment (health Care)
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2007 Higher Education Research Data Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 7 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 6 times in Scopus Article | Citations
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Created: Wed, 15 Aug 2007, 19:52:01 EST