Introducing an innovative, evidence-based resource for use in the emergency department
In early 2008, the National Institute of Clinical Studies (NICS) Stroke Clinical Reference Group was formed to develop an acute stroke care resource for use in emergency departments (EDs) in Australian hospitals. The NICS reference group used a care bundle approach to develop a guideline implementation tool based on specific recommendations from the 2007 National Stroke Foundation (NSF) Clinical guidelines for acute stroke management relevant for ED care.1 Although these guidelines were already available, there are well known barriers to guideline implementation in the ED. These include increasing demand and acuity, and the broad diversity of clinical presentations. Clinical information provided for ED clinicians needs to be concise and relevant to the emergency care context. The nine-member NICS reference group represented a collaboration between stroke and ED specialists, prehospital providers and managers of state-based stroke networks, with additional guidance from the NSF.
The full article is accessible to AMA members and paid subscribers. Login to read more or purchase a subscription now.
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
- 1. National Stroke Foundation. Clinical guidelines for acute stroke management. Melbourne: NSF, 2007. http://www.strokefoundation.com.au/news/welcome/clinical-guidelines-for-acute-stroke-management (accessed Aug 2010).
- 2. Koehler BE, Richter KM, Youngblood L, et al. Reduction of 30-day postdischarge hospital readmission or emergency department (ED) visit rates in high-risk elderly medical patients through delivery of a targeted care bundle. J Hosp Med 2009; 4: 211-218.
- 3. Focht A, Jones AE, Lowe TJ. Early goal-directed therapy: improving mortality and morbidity of sepsis in the emergency department. Jt Comm J Qual Patient Saf 2009; 35: 186-191.
- 4. Nguyen HB, Lynch EL, Mou JA, et al. The utility of a quality improvement bundle in bridging the gap between research and standard care in the management of severe sepsis and septic shock in the emergency department. Acad Emerg Med 2007; 14: 1079-1086.
- 5. Ferrer R, Artigas A, Levy MM, et al. Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. JAMA 2008; 299: 2294-2303.
- 6. Robb E, Jarman B, Suntharalingam G, et al. Using care bundles to reduce in-hospital mortality: quantitative survey. BMJ 2010; 340: c1234.
- 7. Haraden C. What is a bundle? Cambridge, Mass: Institute for Healthcare Improvement. http://www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/ImprovementStories/WhatIsaBundle.htm (accessed Aug 2010).
- 8. National Stroke Foundation. National stroke audit: acute services. Organisational survey report 2009. Melbourne: NSF, 2009. http://www.strokefoundation.com.au/component/option,com_docman/task,cat_view/gid,75/Itemid,174 (accessed Aug 2010).
- 9. National Collaborating Centre for Chronic Conditions. Stroke: national clinical guideline for diagnosis and initial management of acute stroke and transient ischaemic attack (TIA). London: Royal College of Physicians, 2008. http://www.nice.org.uk/nicemedia/live/12018/41363/41363.pdf (accessed Aug 2010).
- 10. Lindsay P, Bayley M, Hellings C, et al. Canadian best practice recommendations for stroke care (updated 2008). CMAJ 2008; 179 (12 Suppl): E1-E93.
- 11. Nor AM, Davis J, Sen B, et al. The Recognition of Stroke in the Emergency Room (ROSIER) scale: development and validation of a stroke recognition instrument. Lancet Neurol 2005; 4: 727-734.
We would like to acknowledge the contribution of the NICS Stroke Clinical Reference Group in the development of the care bundle. The NICS care bundle was reviewed by national and international experts in both clinical care and bundle methodology; endorsed by the NSF, the Australasian College for Emergency Medicine, the Australian College of Emergency Nursing and the College of Emergency Nursing Australasia; and approved by the NHMRC.