Improving discharge care: the potential of a new organisational intervention to improve discharge after hospitalisation for acute stroke, a controlled before-after pilot study

Abstract

OBJECTIVE: Provision of a discharge care plan and prevention therapies is often suboptimal. Our objective was to design and pilot test an interdisciplinary, organisational intervention to improve discharge care using stroke as the case study using a mixed-methods, controlled before-after observational study design.SETTING: Acute care public hospitals in Queensland, Australia (n=15). The 15 hospitals were ranked against a benchmark based on a composite outcome of three discharge care processes. Clinicians from a 'top-ranked' hospital participated in a focus group to elicit their success factors. Two pilot hospitals then participated in the organisational intervention that was designed with experts and consumers. <br />PARTICIPANTS: Hospital clinicians involved in discharge care for stroke and patients admitted with acute stroke or transient ischaemic attack. <br />INTERVENTION: A four-stage, multifaceted organisational intervention that included data reviews, education and facilitated action planning. <br />PRIMARY AND SECONDARY OUTCOME MEASURES: Three discharge processes collected in Queensland hospitals within the Australian Stroke Clinical Registry were used to select study hospitals: (1) discharge care plan; (2) antihypertensive medication prescription and (3) antiplatelet medication prescription (ischaemic events only). Primary measure: composite outcome. Secondary measures: individual adherence changes for each discharge process; sensitivity analyses. The performance outcomes were compared 3months before the intervention (preintervention), 3months postintervention and at 12months (sustainability). <br />RESULTS: Data from 1289 episodes of care from the two pilot hospitals were analysed. Improvements from preintervention adherence were: antiplatelet therapy (88%vs96%, p=0.02); antihypertensive prescription (61%vs79%, p<0.001); discharge planning (72%vs94%, p<0.001); composite outcome (73%vs89%, p<0.001). There was an insignificant decay effect over the 12-month sustainability period (composite outcome: 89% postintervention vs 85% sustainability period, p=0.08). <br />CONCLUSION: Discharge care in hospitals may be effectively improved and sustained through a staged and peer-informed, organisational intervention. The intervention warrants further application and trialling on a larger scale. <br />Cadilhac, Dominique AAndrew, Nadine E <br />Stroil Salama, Enna <br />Hill, Kelvin <br />Middleton, Sandy <br />Horton, Eleanor <br />Meade, Ian <br />Kuhle, Sarah <br />Nelson, Mark R <br />Grimley, Rohan <br />Australian Stroke Clinical Registry Consortium <br />