Clinician-led implementation of clinical guidelines for stroke

Dr Natasha Brusco1, Mr  Doug  McCaskie1, Associate Professor  Helena Frawley1, Mrs Sarah  Foster1

1Cabrini Health, Malvern, Australia, 2La Trobe University, Bundoora, Australia


Aim: To evaluate the impact of implementation of clinical guidelines for stroke management (CGSM) across a private health service.

Method:  A pragmatic, clinician-led implementation of CGSM across a private health service occurred pre-evaluation. The implementation process was reviewed against an evidence-based implementation framework, and for fidelity between the CGSM criteria and the health service stroke policies. The primary outcome was post-implementation, versus pre-implementation, adherence to CGSM criteria across allied health, medical and nursing. Secondary outcomes included post-implementation versus pre-implementation patient satisfaction and cost-effectiveness, and implementation barriers /facilitators, and cost.

Results: The implementation process followed most, but not all, aspects of an evidence-based implementation framework, with inconsistencies between the CGSM and the stroke policies. Post-implementation, adherence to the CGSM criteria significantly improved for 11 (15%) and reduced for one (1%); patient satisfaction (n=8) positively trended; acute admissions (n=100) reported non-significant cost saving [AUD$269 (95%CI: -$1,621 to $2,160)] and non-significant functional improvement [0.02 Modified Rankin Scale (95%CI: -0.45 to 0.48)]; and rehabilitation admissions (n=19) reported significant functional improvement [FIM 10.45 (95%CI: 0.4 to 20.5)]. Barriers to implementation included multi-disciplinary staff collaboration, culture and availability of resources; facilitators included evidence-based policies and a stroke education program. Cost of implementation was ~AUD$155K and involved over 2,000 staff hours. Overall, there was a positive trend post-implementation; however, effectiveness may have been compromised by implementation process limitations.

Significance of the findings to allied health:  These findings support allied health utilising an evidence-based implementation framework to guide implementation of evidenced-based practice, to improve likelihood of desired outcomes.