Please use this identifier to cite or link to this item: https://dora.health.qld.gov.au/qldresearchjspui/handle/1/237
Title: Improving discharge care: The potential of a new organisational intervention to improve discharge after hospitalisation for acute stroke, a controlled before-after pilot study
Authors: Andrew, N. E.
Stroil Salama, E.
Grimley, Rohan 
Kuhle, S.
Hill, K.
Meade, I.
Nelson, M. R.
Cadilhac, D. A.
Middleton, S.
Horton, E.
Issue Date: 2017
Publisher: BMJ Publishing Group
Source: Cadilhac DA, Andrew NE, Stroil Salama E On behalf of the Australian Stroke Clinical Registry Consortium, et al Improving discharge care: the potential of a new organisational intervention to improve discharge after hospitalisation for acute stroke, a controlled before–after pilot study BMJ Open 2017;7:e016010. doi: 10.1136/bmjopen-2017-016010
Journal: BMJ Open
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. Participants Hospital clinicians involved in discharge care for stroke and patients admitted with acute stroke or transient ischaemic attack. Intervention A four-stage, multifaceted organisational intervention that included data reviews, education and facilitated action planning. 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 3 months before the intervention (preintervention), 3 months postintervention and at 12 months (sustainability). 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). 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.L617723012
DOI: 10.1136/bmjopen-2017-016010
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Resources: /search/results?subaction=viewrecord&from=export&id=L617723012http://dx.doi.org/10.1136/bmjopen-2017-016010
Keywords: Patient Discharge;quality improvement;stroke patient;benchmarking
Keywords: antihypertensive agentantithrombocytic agent;anticoagulant therapy;antihypertensive therapy;article;brain ischemia;cerebrovascular accident;clinical effectiveness;emergency care;health care planning;hospital discharge;hospital management;hospitalization;human;observational study;outcome assessment;patient care;pilot study;practice guideline;prescription;public hospital;Queensland;subacute care;total quality management;transient ischemic attack
Type: Article
Appears in Sites:Sunshine Coast HHS Publications

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