Care Of Stroke Patients Research Articles

Potentially preventable hospital readmissions after patients\u2019 first stroke in Taiwan

Readmission is an important indicator of the quality of care. The purpose of this study was to explore the probabilities and predictors of 30-day and 1-year potentially preventable hospital readmission (PPR) after a patient’s first stroke. We used claims data from the National Health Insurance (NHI) from 2010 to 2018. Multinomial logistic regression was used to assess the predictors of 30-day and 1-year PPR. A total of 41,921 discharged stroke patients was identified. We found that hospital readmission rates were 15.48% within 30-days and 47.25% within 1-year. The PPR and non-PPR were 9.84% (4123) and 5.65% (2367) within 30-days, and 30.65% (12,849) and 16.60% (6959) within 1-year, respectively. The factors of older patients, type of stroke, shorter length of stay, higher Charlson Comorbidity Index (CCI), higher stroke severity index (SSI), regional hospital, public and private hospital, and hospital in the lower urbanized area were associated significantly with the 30-day PPR. In addition, the factors of male, hospitalization year, and monthly income were associated significantly with 1-year PPR. The ORs of long-term PPR showed a decreasing trend since implementing the national health insurance post-acute care (PAC) program in 2014 and a dramatic drop in 2018 after the government expanded the long-term care plan-LTC 2.0 in 2017. The results showed that better discharge planning, implementing post-acute care programs and long-term care plan-LTC 2.0 may benefit the care of stroke patients and help reduce long-term readmission in Taiwan.

Current State of Stroke Care in Vietnam

Stroke is the leading cause of death and disability in Vietnam. This review aims to assess the current status of the stroke care system and quality criteria in the acute phase at stroke hospitals. In 2016, the Ministry of Health in Vietnam issued Circular 47, a mandate to build stroke units in Vietnam. The ANGELS program, which is supporting the World Stroke Organization to gain its goals, was implemented in 18 stroke‐ready hospitals in Vietnam to help address quality of stroke patient care in 2017. From the results achieved, we will continue to improve policies, strive to reach stroke benchmark goals, as well as plan to implement solutions in the future to build a better stroke system of care infrastructure in Vietnam.

Improving the Prehospital Identification and Acute Care of Acute Stroke Patients: A Quality Improvement Project.

Background There are a large number of stroke patients in China, and there is currently a lack of prehospital acute stroke care training programs. Aim To develop a prehospital emergency medical service (PEMS) training program to improve the prehospital identification and acute care of acute stroke. Methods Forty prehospital emergency doctors whose service stations are located within a 10 km radius from Shanghai Pudong New Area Medical Emergency Service Center took this course on November 13, 2014. A questionnaire was designed to evaluate the PEMS personnel's knowledge in stroke and acute stroke care and was conducted before and after training as an assessment of the effectiveness of training. The patient population in this study included a baseline cohort before training and a prospective cohort after training, each composed of patients who were sent to Shanghai East Hospital South Stoke Center within one year. The transit time, final diagnosis, administration of thrombolysis, and door-to-needle time (DNT) were collected and analyzed. Results After the training, 100% of the PEMS personnel were competent to identify stroke cases using the Cincinnati prehospital stroke scale (CPSS). All participants realized that intravenous thrombolysis therapy in a time-sensitive manner is the most effective way to treat acute ischemic stroke. Although there was no difference in first-aid transit time before and after training, the stroke diagnosis rate improved by 6.5% after training (P=0.03). The thrombolysis rate increased to 29.6% from 24.3% but did not reach statistical significance. Compared to 84.0 minutes (standard deviation: 23.1 minutes) before the training, the average DNT after training was 53 minutes (standard deviation: 15.0 minutes), demonstrating a remarkable reduction (P < 0.01). Conclusion The training program effectively improved the PEMS personnel's knowledge in stroke and stroke acute care.

Abstract WP30: Zoom Or In The Room, Meeting The Stroke Education Standard

Background: Comprehensive Stroke Center nurses are required to receive 8 hours of stroke education annually; meeting this objective has been a challenge for administrators due to staffing shortages as well as the need to social distance during the COVID pandemic prompting virtual learning as a method to meet these standards. Web based courses often lack the multiplicity of diverse learning modalities needed for success. Purpose: Our objective was to provide a meaningful way to provide stroke education using the six perceptual modalities needed for adult learning which included visual, aural, printed, tactile, interactive, and kinesthetic learning. Methods: The stroke administrative team conducted a needs analysis based on nursing requests, outcome metrics, and requirements of the Joint Commission. A hybrid approach was delivered to the staff using four hours of classroom didactics, three hours of online classes, and one hour of education at hospital skills fairs, and unit meetings. Classrooms utilized social distancing, requiring multiple classes to be offered. Results: Nurses were surveyed with a 12 question Likert scale about how well they were prepared to integrate learned material into clinical practice comparing both virtual and live modalities. They were also asked about individual learning modalities. Twenty-five people responded to the survey. Only 12% of virtual learner respondents felt strongly prepared to care for stroke patients compared to 76% of classroom learners. Seventy-nine percent preferred classroom learning compared to 17% virtual, with a 4% hybrid preference. Learning preferences were multifactorial for visual, aural, printed, tactile, interactive, and kinesthetic learning being 95%, 48%, 56%, 40%, 11%, and 20% respectively. Conclusions: Virtual learning provides solutions in difficult situations, however classroom education is the preferred method of learning for healthcare professionals delivering evidenced based care for acute stroke patients. Planning committees should at least consider a hybrid approach that offer classroom time to caregivers.

Abstract TP95: Characterization And Comparison Of Hospitalization Outcomes Between Symptomatic And Asymptomatic Urinary Tract Infection In Acute Ischemic Stroke Patients

Background: Urinary Tract Infection (UTI) has been associated with increased cost of care and poor outcomes in stroke patients. Guidelines from the Infectious Disease Society of America do not support treating asymptomatic UTI in the absence of objective markers of infection. Aims: Characterize demographics and hospitalization outcomes of symptomatic (sUTI) and asymptomatic (aUTI) in stroke patients compared to a control group without infectious complication. Method: This is a single center retrospective cohort study using the 2019 ischemic stroke database at the University of Kentucky. Cases were defined as patients with confirmed UTI on urine culture or urinalysis, and without other infections. Cases were subdivided into sUTI (subjectively endorsing UTI symptoms or objective vitals suggestive of infection) and aUTI group (reason for urine studies being encephalopathy or leukocytosis without fever). Controls were defined as patients without evidence of infection, and matched to the case group by age and sex. Demographics (age, sex, and stroke mechanism) were compared using Chi-squared analysis. Outcomes included length of stay (LOS), change in pre-hospital to discharge modified Rankin Scale (delta mRS), delta NIHSS (difference between admission and discharge NIHSS), and % change in NIHSS ((highest NIHSS -lowest NIHSS)/admission NIHSS)). Mean and standard deviation between the 3 groups were compared using ANOVA. Results: A total of 120 cases were identified as having UTI (sUTI = 35; aUTI = 85), with nearly all receiving antimicrobials. No difference in demographics was observed between sUTI and aUTI, except for stroke mechanism (p=0.007 for chi-squared comparison of TOAST classification). Both sUTI and aUTI had greater morbidity as defined by delta mRS compared to control (p=0.0066; p=0.0001 respectively), but not to each other (p=0.0625). Only sUTI resulted in longer LOS compared to control (p=0). No difference in delta or % change NIHSS was observed between the 3 groups. Conclusion: Both sUTI and aUTI were associated with poor outcome in mRS, which may suggest impaired stroke recovery. Withholding antibiotic treatment in aUTI, as suggested by IDSA guidelines, may lead to worse outcomes. Further study is needed to determine the impact of non-treatment.

Abstract WP31: Really, Did A Code Stroke Simulation Improve Compliance In Patient Care Requirements?

Purpose: Enhance the care of ischemic stroke patients by improving compliance with implementation of appropriate order sets, following protocols addressing assessment of vital signs, neuro checks, and lowering door to needle times. Method: ED nurses were required to attend one of five simulation skills fair offered over a nine month period. A stroke simulation scenario was provided in the simulation lab. Groups of nurses performed each step in the care of a code stroke patient. An ED nurse facilitated each step to assure the staff had an understanding of time related events such as calling code stroke, identifying the exact time of last seen well, obtaining CT, vital signs, labs, neuro checks, scoring the patient, and administration of Alteplace, if applicable. Results/Outcomes: Metrics for fiscal year were compared to the statistics collected for the last quarter of fiscal year. Implementation of the stroke order set rose 56.4%, from 43.6% to 100%. Compliance with the protocol, neuro checks improved 40% to 90% and documentation of vital signs per protocol rose from 90% to 97%. Door to needle time improved by 11 minutes. Implications: The simulation educational intervention proved to show a significant improvement in compliance in performing vital signs, neuro checks, using stroke order sets and especially door to needle times. The ED leadership team has recognized the significant impact to our patient care outcomes and compliance resulting from providing this simulation education. The simulation also identified that the majority of the staff did not understand how to correctly perform neuro checks and were not placing the correct code stroke order sets that included the orders to do vital signs and neuro checks per protocol.

Abstract WP156: Association Of Thrombus Histopathology And Prognosis Of Successful Recanalization

Introduction: Mechanical thrombectomy (MT) has become the standard of care for acute ischemic stroke (AIS) patients due to large vessel occlusion (LVO). Clinical outcome of successful recanalization (mTICI 2b or higher) varies greatly and is associated with some baseline characteristics. Many studies have reported the relation of thrombus composition with MT outcomes however the association of thrombus composition with the prognosis of successful recanalization remains to be elucidated. Hypothesis: thrombi retrieved from patients with good clinical outcome may have different compositions compared to that of patients with poor clinical outcome. Methods: Thrombi retrieved from AIS-LVO patients with successful recanalization were included. Patients were divided according to modified Rankin Scale at 90 days (mRS-90days) into good clinical outcome (mRS-90days 0-2) and poor clinical outcome (mRS-90 days 3-6). Representative slide for each thrombus was stained with Martius Scarlet Blue (MSB) for red blood cells (RBCs), white blood cells (WBCs), fibrin (FIB), and platelet (PLT). Immunohistochemistry (IHC) was also performed for NETs (anti-citrullinated H3; CitH3) and vWF in thrombi. The overall mean value of each thrombus composition was calculated. Thrombus was considered rich in given composition if that composition was higher than its overall mean. We compared the thrombus composition and type between patients with good and poor clinical outcomes. Results: A total of 94 patients were included. Fifty-six patients had good clinical outcome. The overall average percentage of RBCs, WBCs, fibrin, platelet, NETs (CitH3), and vWF components in thrombi were 44.3%, 3.6%, 29.3%, 22.8%, 20.3% and 12.5% respectively. There was no association between thrombus type (including RBC-rich, FIB-rich, PLT-rich, vWF-rich, and NETs-rich) and clinical outcomes (P values&gt;0.05). Multivariate logistic regression analysis showed no association between thrombus composition and clinical outcome (good vs poor) while adjusting for age, initial NIHSS score, ASPECT score, pre-MT IV-tPA, and MT technique and number of the device passes. Conclusion: we found no association between thrombus composition and clinical outcome after successful recanalization.

Abstract WP53: Highly Visible Wall-timer To Reduce Endovascular Treatment Time For Stroke

Background and Purpose: Endovascular therapy for acute ischemic stroke has revolutionized clinical care for stroke patients with large vessel occlusion (LVO), but treatment remains time sensitive. At our stroke center, up to half of the door-to-groin time is accounted for after the patient arrives in the neuro-interventional radiology (NIR) suite. Here we apply the concept of a highly visible timer in the NIR suite to quantify the impact on endovascular treatment time in stroke patients with LVO. Methods: This was a single-center prospective pseudo-randomized study conducted over a 32-week period (September 14, 2020 through April 25, 2021). Pseudo-randomization was achieved by turning the timer on and off in 2-week intervals. The primary outcome and secondary outcomes were reduction in IR to groin time and 90-day mRS, respectively. We also performed a stratified analysis based on anesthesia status for the procedure along with a multivariate regression to evaluate the effect of the intervention on treatment time while accounting for endotracheal intubation. Results: During the 32-week study period, 97 mechanical thrombectomies were performed. The timer was ON and OFF for 38 and 59 cases, respectively. The timer resulted in a reduction in IR-to-groin time (27.7 mins vs 32.6 mins; p=0.02). Endotracheal intubation (80% of overall cohort) was associated with a longer NIR-to-groin time (33 mins vs 23 mins; p&lt;0.05). Among patients that underwent intubation, the timer resulted in a reduction in IR-to-intubation time (29.5 mins vs 34.4 mins; p=0.03). After adjusting for intubation status in a multivariate regression, the timer was associated with a 5-minute reduction in IR-to-Groin time (p=0.02). There was no difference in the 90-day mRS between both groups. Conclusions: A highly visible timer in the NIR suite achieved a meaningful, albeit modest, reduction in endovascular treatment time for stroke patients with LVO. A larger study would be necessary to measure a potential impact on long-term functional outcome, and a multi-center study may be necessary to confirm generalizability. However, based on these results, the lack of risk, and low cost, it is reasonable for stroke centers to consider using a highly visible timer in the NIR suite to improve stroke treatment times.

Abstract WP40: Improving Novices Stroke Nurses’ Education To Improve Patient Outcomes

Problem: Stroke care is a lifelong chronic disease process that is constantly evolving for patients and the hospitals that care for them. Today's evidence-based care of stroke patients is time-sensitive and time-intensive for the registered nurse (RN). With the growing incidence of stroke, there is an emerging need for nurses’ education and timely bedside assessment. Eighty percent of strokes are preventable through risk factor management, and twenty percent of stroke patients will have a recurrence. Nurses are primarily responsible for providing this education. However, new stroke nurses in the Emergency Room or on the stroke unit may not have this foundation of knowledge or know the current evidence-based practice, which is often not taught in school. Purpose: The purpose of this study is to evaluate nursing knowledge and performance at baseline, post education intervention, and again two months after implementation to determine if providing several different education techniques improves knowledge, performance, and retention during a quality improvement project. EBP Questions: RQ1: Is there a significant difference between stroke knowledge test scores before, immediately after, and two months after receiving an evidence based educational intervention. • RQ2: Is there a significant difference in stroke code simulation scores before, immediately after, and two months after receiving an evidence based educational intervention. • RQ3: Is there a correlation between nurse’s stroke code simulation scores at two months and their years of experience as a nurse? Methods: A quasi-experimental design will be used to compare the knowledge novice stroke nurses at baseline. Again, after a four-hour lecture. Finally, after simulation they will again be tested for knowledge. Outcome: The expected outcome is that staff knowledge will increase with each simulation. As the nurses continue to learn and practice, they should increase awareness of stroke signs and symptoms for patients arriving in the emergency room through triage or EMS. Significance: This study will contribute to evidence-based research to determine if multi-faceted education techniques are best when training novice nurses to new time sensitive processes in this critical access hospitals.

Abstract TP45: Promoting High Value Care For Stroke Patients Within A Stroke System Of Care: Reducing Unnecessary Hospital Transfers For Patients Not Taken For Thrombectomy

Introduction: High value care aims to provide the best patient outcomes while avoiding defects and waste. Our previous work determined that 39% of patients transferred for possible thrombectomy based on clinical criteria and CT only did not have a large vessel occlusion (LVO) which led to a health system-wide guideline to improve transfer selection by adding criteria for emergent CT angiography. This study aims to describe the impact of that guideline and reanalyze the reasons why patients transferred for consideration of thrombectomy do not receive the procedure. Methods: All patients transferred from within and outside of the health system as a potential thrombectomy candidate between 1/1/19- 6/30/21 were reviewed for reasons why thrombectomy was not pursued. Results: Over 30 months, 316 patients transferred for possible thrombectomy were not taken to the angio suite primarily due to absence of LVO on vessel imaging (26.3%), lack of suspicion of LVO on assessment (18%) and significant improvement in clinical symptoms (12%). Other reasons included too large of core infarct (13.3%), CT head ASPECT score (8.2%), lack of perfusion imaging mismatch (6.3%), poor baseline functional status (4.7%), lesion too distal (3.8%), ICH (3.2%), time since last known well (1.9%), chronic ICA occlusion preventing access to acute lesion (1.9%), and medically unstable (0.3%). Conclusions: Despite the institution of a system-wide protocol for acute CTA imaging to guide patient selection, the major reason for not proceeding to thrombectomy was still absence of LVO, some of which was related to out-of-system hospital transfers. Drawbacks of unnecessary patient transfer include increased cost of care, moving patients farther away from their home and family, and non-essential use of tertiary hospital bed space, particularly in the setting of a pandemic. Given the prevalence of potentially preventable unnecessary transfers, protocols that support in-the-field triage and transport based on clinical criteria alone, without CT or CTA, are destined to worsen health system efficiency and decrease the value of care for patients with major acuteischemic stroke.

Evaluating the impact of evidence-based nursing in combination with clinical nursing pathway for nursing care of patients with stroke: A protocol for systematic review and meta-analysis.

Objectives:Strokes are among the leading conditions that lead to disability and death. Currently, there is a lack of ideal nursing care for stroke patients. The aim of this study is to assess the effect of combining evidence-based nursing and clinical nursing pathway to establish a nursing model to provide care for patients who suffered a stroke.Methods:A comprehensive search of online-based databases will be carried out to identify relevant publications, the databases include EMBASE, Cochrane Library, PubMed, VIP databases, Chinese National Knowledge Infrastructure, and WanFang database. The search will consider all Randomized Controlled Trials, interrupted time series studies, and controlled before and after studies, all related to providing care for neurology and strokes by combining evidence-based nursing and clinical nursing pathway to elevate access and outcomes for patients with stroke. The language of publications will be restricted to English and Chinese. The author will select studies, extract data, and evaluate the quality of the involved articles. RevMan 5.3 software will be employed to perform all statistical analysis.Results:The outcomes of the proposed study will provide scientific evidence for the nursing care of evidence-based nursing combined with clinical nursing pathway for stroke patients.Conclusion:The planned systematic analysis will be first to examine the effect of combining evidence-based nursing and clinical nursing pathway to present a nursing model to treat stroke patients.Registration number:November 16, 2021.osf.io/6zr5a/. (https://osf.io/6zr5a/).

Mobile Health Application to Support Family Caregivers in Recurrent Stroke Prevention: Scoping Review

BACKGROUND OF THE STUDY: Caregivers play a vital role in continuum care for stroke patients. Involvement of caregivers in stroke care was important. With the advancement of information technology and the rapid growth worldwide in cell-phone use and internet connectivity, additional evidence may be needed in the use of mobile applications to support caregivers in stroke care.&#x0D; AIM OF THE STUDY: The aims of this review was to identify existing mobile application designed to support family caregivers of people with stroke disease.&#x0D; METHODOLOGY: A scoping review study framework was carried out in this study, using the EBSCO, Cochrane, PubMed, ProQuest, and Science Direct databases using search keywords: ‘family caregiver’, ‘mobile health application’, and ‘recurrent stroke or secondary stroke prevention’. This review examined studies published between January 2011 and December 2020. Of a total of 728 papers found, 9 journals were selected. RESULTS: The results founded three categories and their attendant sub-categories. The categories was caregivers support, involvement caregivers in stroke care, and barriers. The majority of mobile application was used to provide video education for caregivers. Caregivers involved in stroke care including emotional care, nutrition, exercise, and recurrent stroke prevention. Poor connection was the most barrier in using mobile application.&#x0D; CONCLUSION: Mobile application can support caregivers in stroke care. Healthcare providers are expected to utilize mobile applications in helping caregivers in post-stroke care.

Meta-analysis of risk factors associated with suicidal ideation after stroke

BackgroundOver the past decade, increasing attention has been paid on post stroke suicide (PSS), which is one of complications of stroke. The rates of stroke and suicide are relatively high, especially in Asian populations. Thus, a deeper understanding of the prevalence and epidemiological impact of suicide after stroke is urgently needed. Clinical diagnosis and prevention of PSS are at the incipient stage, but the risk factors responsible for the occurrence of PSS in different regions and stages of the disease remain largely unknown. The present meta-analysis aimed to determine the incidence of PSS at different stages and time courses, and to identify the underlying risk factors for PSS.MethodsWe systematically searched the Cochrane library, Embase, PubMed, CNKI and Web of Science databases from their inception until April 2019.The research articles reporting on the risk factor for PSS were screened and included in the meta-analysis. The data from the included studies were extracted according to the predefined criteria.ResultsA total of 12 studies (n = 2,693,036) were included for meta-analyses. Of these studies, 7 reporting suicide prevalence were meta-analyzed. The pooled estimate of suicidal ideation rates after stroke was 12%, which could be influenced by multiple risk factors, including sex, smoking, depression, sleep disorders, previous stroke and low household income. Studies conducted in Asia demonstrated higher suicide prevalence (approximately 15%) compared to other regions. Smoking, low family income, depression, heart disease and sleep disorders were important risk factors for PSS. When compared to PSS of more than 1 year, the incidence of suicide within 1 year after stroke was more likely to be statistically significant. It was found that 4 out of every 1000 stroke survivors tended to commit suicide. The results of this meta-analysis showed that depression (OR = 2.32; p < 0.01) was significantly associated with suicidal ideation, regardless of stroke duration.ConclusionPSS is one of the common complications of stroke. Despite some limitations, we successfully identified the risk factors associated with suicidal ideation after stroke. Notably, depression was significantly associated with suicidal ideation, regardless of stroke duration. Targeting this risk factor may be helpful to improve stroke patient care and prevent suicidal ideation after stroke. Future research will be carried out to assess whether suicidal ideation or thoughts and actual suicide attempts are strongly predictive of suicide deaths after stroke (Registration No. CRD42019128813).

Annual Case Volume and One-Year Mortality for Endovascular Treatment in Acute Ischemic Stroke.

BackgroundThe association between endovascular treatment (EVT) case volume per hospital and clinical outcomes has been reported, but the exact volume threshold has not been determined. This study aimed to examine the case volume threshold in this context.MethodsNational audit data on the quality of acute stroke care in patients admitted via emergency department, within 7 days of onset, in hospitals that treated ≥ 10 stroke cases during the audit period were analyzed. Ischemic stroke cases treated with EVT during the last three audits (2013, 2014, and 2016) were selected for the analysis. Annual EVT case volume per hospital was estimated and analyzed as a continuous and a categorical variable (in quartiles). The primary outcome measure was 1-year mortality as a surrogate of 3-month functional outcome. As post-hoc sensitivity analysis, replication of the study results was examined using the 2018 audit data.ResultsWe analyzed 1,746 ischemic stroke cases treated with EVT in 120 acute care hospitals. The median annual EVT case volume was 12.0 cases per hospital, and mortality rates at 1 month, 3 months, and 1 year were 12.7%, 16.6%, and 23.3%, respectively. Q3 and Q4 had 33% lower odds of 1-year mortality than Q1. Adjustments were made for predetermined confounders. Annual EVT case volume cut-off value for 1-year mortality was 15 cases per year (P < 0.02). The same cut-off value was replicated in the sensitivity analysis.ConclusionAnnual EVT case volume was associated with 1-year mortality. The volume threshold per hospital was 15 cases per year.

ОКАЗАНИЕ МЕДИЦИНСКОЙ ПОМОЩИ БОЛЬНЫМ С ИНСУЛЬТОМ В РЕГИОНАЛЬНОМ СОСУДИСТОМ ЦЕНТРЕ ГОРОДА ХАНТЫ-МАНСИЙСКА

The case histories of 692 stroke patients hospitalized in the regional vascular center of the KhantyMansiysk Regional Clinical Hospital for the period from 2019–2021 were analyzed in order to assess the epidemiological characteristics, clinical aspects of the course to assess the eff ectiveness of specialized medical care for these patients and optimize the stroke prevention program. The number of stroke patients treated at the regional vascular center decreased by 25.4% in 2020 and increased by 31.6% in 2021. in connection with the COVID-19 pandemic. There was also an increase in the number of recurrent ischemic strokes in 2021 by 29.4% compared to 2020, which may indicate insuffi cient prevention of recurrent stroke during the COVID-19 pandemic. In total, 45.4% of patients were admitted in the fi rst 6 hours after the onset of stroke symptoms, so it is necessary to raise public awareness through social advertising to prevent late access to medical care for stroke patients

Application of Improved Clinical Response Measures Based on Early Warning Score in the Care of Stroke Patients

Application of Improved Clinical Response Measures Based on Early Warning Score in the Care of Stroke Patients

Disparities in Care and Outcome of Stroke Patients from Culturally and Linguistically Diverse Communities in Metropolitan Australia.

Background: Acute stroke is a time-critical emergency where diagnosis and acute management are highly dependent upon the accuracy of the patient’s history. We hypothesised that the language barrier is associated with delayed onset time to thrombolysis and poor clinical outcomes. This study aims to evaluate the effect of language barriers on time to thrombolysis and clinical outcomes in acute ischemic stroke. Concerning the method, this is a retrospective study of all patients admitted to a metropolitan stroke unit (Melbourne, Victoria, Australia) with an acute ischemic stroke treated with tissue plasminogen activator between 1/2013 and 9/2017. Baseline characteristics, thrombolysis time intervals, length of stay, discharge destination, and in-hospital mortality were compared among patients with and without a language barrier using multivariate analysis after adjustment for age, sex, stroke severity, premorbid modified Rankin Scale (mRS), and Charlson Comorbidity Index (CCI). Language barriers were defined as a primary language other than English. A total of 374 patients were included. Our findings show that 76 patients (20.3%) had a language barrier. Mean age was five years older for patients with language barriers (76.7 vs. 71.8 years, p = 0.004). Less non-English speaking patients had premorbid mRS score of zero (p = 0.002), and more had premorbid mRS score of one or two (p = 0.04). There was no statistically significant difference between the two groups in terms of stroke severity on presentation (p = 0.06). The onset to needle time was significantly longer in patients with a language barrier (188 min vs. 173 min, p = 0.04). Onset to arrival and door to imaging times were reassuringly similar between the two groups. However, imaging to needle time was 9 min delayed in non-English speaking patients with a marginal p value (65 vs. 56 min, p = 0.06). Patients with language barriers stayed longer in the stroke unit (six vs. four days, p = 0.02) and had higher discharge rates than residential aged care facilities in those admitted from home (9.2% vs. 2.3%, p = 0.02). In-hospital mortality was not different between the two groups (p = 0.8). In conclusion, language barriers were associated with almost 14 min delay in thrombolysis. The delay was primarily attributable to imaging to needle time. Language barriers were also associated with poorer clinical outcomes.

Transition of care in stroke patients discharged home: a single-center prospective cohort study

IntroductionApproximately two-thirds of the patients admitted to the hospital with an ischemic stroke are discharged directly home. Discontinuity of care may result in avoidable patient harm, re-admissions and even death. We hypothesized that the transfer of information is most essential in this patient group since any future care for these patients relies solely on the information that is available to the care provider responsible at that time.AimThe objective of this study was to evaluate the continuity of transmural care in ischemic stroke patients by assessing 1) the transfer of clinical information through discharge letters to general practitioners (GPs), 2) subsequent documentation of this information and early follow-up by GPs and 3) the documentation of medication-related information in discharge letters, at GPs and community pharmacies (CPs).MethodsThis prospective cohort study was conducted from September 2019 through March 2020 in OLVG, Amsterdam, the Netherlands, in patients with a first stroke discharged directly home. Outcome measures were derived from national guidelines and regional agreements. Results were analyzed using descriptive analysis.ResultsA total of 33 patients were included. Discharge letters (n = 33) and outpatient clinic letters (n = 24) to GPs contained most of the essential items, but 16% (n = 9) of the letters were sent in time. GPs (n = 31) infrequently adhered to guidelines since 10% (n = 3) of the diagnoses were registered using the correct code and 55% (n = 17) of the patients received follow-up shortly after discharge. Medication overviews were inaccurately communicated to GPs since 62% (n = 150) of all prescriptions (n = 243) were correctly noted in the discharge letter. Further loss of information was seen as only 39% (n = 95) of all prescriptions were documented correctly in GP overviews. We found that 59% (n = 144) of the prescriptions were documented correctly in CP overviews.ConclusionIn this study, we found that discontinuity of care occurred to a varying extent throughout transmural care in patients with a first stroke who were discharged home.

Validity and reliability testing of home care stroke quality indicators

&lt;p&gt;It is disconcerting that until today there are no agencies or research to recommend the appropriate indicators of home nursing care of stroke patients according to Indonesian conditions. Hence, this research aimed to verify the validity and reliability of quality indicators of home nursing care for stroke patient that resulted from Delphy process. Confirmatory factor analysis was carried out for validity and reliability testing with data collected from 350 respondents. Based on the value of loading factors, 62 indicators were declared valid and five indicators were invalid. This study successfully proved the validity of 62 indicators of quality home care for stroke patients. Further research is needed to pilot project this indicator in a larger area.&lt;/p&gt;

Nursing and Allied Health Staff Perceptions and Experiences of a Volunteer Stroke Peer Support Program: A Qualitative Study.

PurposeStroke brings about physical, cognitive, and psychosocial changes and, consequently, many stroke survivors feel underprepared for the transition from hospital to home. Nursing and allied health staff have a key role in stroke rehabilitation. Peer support programs have been found effective in supporting stroke survivors, alongside hospital staff caring for stroke patients, by providing experiential knowledge that staff are not able to provide.AimThis study explored the perceptions and experiences of nursing and allied health staff of a volunteer peer support program for stroke inpatients.MethodsThis study utilised a qualitative, evaluative case study design. This study was conducted at a public metropolitan hospital in Western Australia that had developed a stroke peer support program (SPSP) on a rehabilitation ward. A purposeful sample of nurses (n = 5) and multidisciplinary allied health staff (n = 5) were recruited from the ward where the SPSP was provided for stroke inpatients. Semi-structured, face-to-face interviews were conducted with staff participants. Verbatim transcripts from audio-recorded interviews were analysed using inductive thematic analysis.ResultsNursing and allied health staff perceived the SPSP as valuable to stroke patients’ rehabilitation and beneficial to families, volunteer peers and staff. Four themes encapsulated the findings: awareness of and involvement in the program; recognising the benefits of the program; perceived enablers and barriers of the program and suggestions for the future of the program.ConclusionNursing and allied health staff within multidisciplinary teams are cognisant of the psycho-emotional needs of stroke patients which staff are not fully able to meet. The study findings confirm volunteer peer support can provide valuable and fundamental adjunct support to address stroke patients’ unmet needs, as well as supporting staff to enhance stroke patient care.