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Improving discharge from hospital after stroke: A focus on prevention medication and discharge planning
Abstract   Peer reviewed

Improving discharge from hospital after stroke: A focus on prevention medication and discharge planning

D A Cadilhac, N Andrew, E Salama, I Meade, S Kuhle, L Dunstan, Eleanor Horton, Sandy Middleton and R Grimley
International Journal of Stroke, Vol.10(Supplement 3), p.10
Joint Conference: 26th ASM of the Stroke Society of Australasia and the 11th Australasian Nursing and Allied Health Stroke Conference, 2015 (Melbourne, Australia, 02-Sep-2015–04-Sep-2015)
2015
DOI: https://doi.org/10.1111/ijs.12584
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https://doi.org/10.1111/ijs.12584View
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Abstract

Clinical Sciences Neurosciences stroke care discharge care planning prevention medication secondary stroke prevention
Introduction: Hospitals that provide stroke care vary in performance related to discharge care planning and secondary stroke prevention. Aim: To design and pilot a quality improvement program to reduce disparities between hospitals for discharge planning and secondary prevention. Methods: Three discharge indicators collected in Queensland hospitals within the Australian Stroke Clinical Registry (AuSCR) were used: 1) discharge care plan; 2) antihypertensive medication prescription; and 3) antiplatelet medication prescription if an ischemic event. An aggregated performance score was calculated for each hospital. Clinicians from an exemplar hospital with 'top performance' were part of a focus group to elicit their success factors. Two hospitals with performance levels below their peers then participated in an evidence-based, multifaceted interven- tion that included data reviews; sharing of exemplar hospital success factors and two workshops resulting in development of an action plan. AuSCR data were reviewed 2-3 months after workshop 2 and compared to the pre-intervention results. Results: The aggregated score improved for each site post intervention (site 1: 18% [p = 0.01]; site 2: 30% [p = 0.005]). Both achieved significant improvements for adherence to discharge care planning (site 1: 46% [p = 0.004]; site 2: 67% [p < 0.001]) and one site significantly improved adherence to prescription of antihypertensive medications at discharge (site 2: 31% [p = 0.04]). Due to ceiling effects no significant improvement was observed in adherence to prescription of antiplatelet medication. Conclusion: The methods used in this pilot project contribute to imple- mentation science methods and provide evidence that further testing of the intervention in more hospitals would be worthwhile.

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