Enablers of the implementation of tissue plasminogen activator in acute stroke care: a cross-sectional survey.

Alice Grady,Rob Sanson-Fisher,Mariko Carey,Jamie Bryant,Chris Paul,Xiaoying Wang

doi:10.1371/journal.pone.0114778

Alice Grady, Rob Sanson-Fisher + Show 4 more

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https://doi.org/10.1371/journal.pone.0114778

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Journal: PloS one	Publication Date: Dec 9, 2014
Citations: 7	License type: CC BY 4.0

Affiliation: Hunter Medical Research Institute

Abstract

ObjectiveTo assess emergency physicians’ perceptions of individual and system enablers to the use of tissue Plasminogen Activator in acute stroke.MethodAustralian fellows and trainees of Australasian College for Emergency Medicine completed a 57-item online survey assessing enablers to implementation of evidence-based practice across six domains: knowledge, skills, modelling, monitoring, feedback, and maintenance. Demographic and workplace characteristics were obtained. Descriptive statistics were calculated to describe demographic and workplace characteristics of responders, and survey responses. Each domain received an overall score (%) based on the number of responders agreeing with all items within the domain.ResultsA total of 429 (13%) Australasian College for Emergency Medicine members responded. 17.7% of respondents reported they and/or their workplace met all knowledge-related enablers, however only 2.3% had all skill-related enablers in place. Of respondents who decide which patients receive tissue Plasminogen Activator treatment, 18.1% agreed that all maintenance-related enablers are in place at their hospital, compared to 6.6% for those who do not decide which patients receive tissue Plasminogen Activator treatment. None of the respondents had all items in place cross all domains.ConclusionsEven when allowing for the low response rate, it seems likely there is a lack of individual and system enablers supporting the implementation of best-practice stroke care in a number of Australian hospitals. Quality improvement programs could target all domains, particularly the skills-training and feedback emergency physicians receive, to aid implementation of tissue Plasminogen Activator treatment for acute stroke.

Highlights

Burden of the evidence-practice gap Despite existence of evidence-based recommendations to guide clinical behaviour, these are often not adopted into practice [1]
We have reported data on emergency physicians’ attitudes regarding the evidence, benefits and harms associated with tissue plasminogen activator (tPA) elsewhere, so these data are not reported in this manuscript
Our results are supported by previous international literature relating to workplace resources for stroke care, physician perceptions of tPA use, and strategies for producing behaviour change

Summary

Introduction

Burden of the evidence-practice gap Despite existence of evidence-based recommendations to guide clinical behaviour, these are often not adopted into practice [1]. It is estimated that 30–40% of patients do not receive potentially beneficial treatments [2]. Optimal implementation of best-evidence clinical practice requires changes across all stages [5]. The evidence-practice gap in acute stroke treatment. Use of thrombolytic therapy with intravenous tissue plasminogen activator (tPA) in appropriately selected acute ischaemic stroke patients is a powerful [7] and costeffective [8] intervention. In Australia, tPA is currently administered to 7% of ischaemic stroke patients [10], and 53% of hospitals offer this treatment [11]. Rates of tPA use are similar in other countries; in the United Kingdom 5% of stroke patients receive treatment [12], and 7% of ischaemic stroke patients are treated in the United States [13]

Results

Discussion

Conclusion