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

Dominique A Cadilhac; Nadine E Andrew; Enna Stroil Salama; Kelvin Hill; Sandy Middleton; Eleanor Horton; Ian Meade; Sarah Kuhle; Mark R Nelson; Rohan Grimley

doi:10.1136/bmjopen-2017-016010

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

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

Dominique A Cadilhac, Nadine E Andrew, Enna Stroil Salama, Kelvin Hill, Sandy Middleton, Eleanor Horton, Ian Meade, Sarah Kuhle, Mark R Nelson and Rohan Grimley

BMJ Open, Vol.7(8), e016010

2017

DOI: https://doi.org/10.1136/bmjopen-2017-016010

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Abstract

discharge care

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.

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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: Dominique A Cadilhac (Author) - Monash University
Nadine E Andrew (Author) - Monash University
Enna Stroil Salama (Author) - University of Queensland
Kelvin Hill (Author) - Stroke Foundation
Sandy Middleton (Author) - Australian Catholic University
Eleanor Horton (Author) - University of the Sunshine Coast - Faculty of Science, Health, Education and Engineering
Ian Meade (Author) - Townsville Hospital
Sarah Kuhle (Author) - Redcliffe Hospital
Mark R Nelson (Author) - University of Tasmania
Rohan Grimley (Author) - University of Queensland
Publication details: BMJ Open, Vol.7(8), e016010; 11
Publisher: B M J Group
Date published: 2017
DOI: 10.1136/bmjopen-2017-016010
ISSN: 2044-6055
Copyright note: Copyright © 2017 The Author. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Organisation Unit: University of the Sunshine Coast, Queensland; School of Nursing, Midwifery and Paramedicine - Legacy
Language: English
Record Identifier: 99451041502621
Output Type: Journal article

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