Preferences, barriers and facilitators for establishing comprehensive stroke units: a multidisciplinary survey
Question 1: What is your view of the quality of the article?
This article is well written with good general flow of thought and easy for the reader to follow. Survey methodology is employed to capture data for quantitative analysis.1
The question asked pertains to a “comprehensive stroke unit (CSU)” model of care. It stems from 2 Cochrane database reviews (02, 07) by the Stroke Unit Trialists’ Collaboration (SUTC) that showed survival and dependency benefits of “organized inpatient (stroke unit) care”.2, 3 These reviews however did not differentiate between models of ...view middle of the document...
Surveys were distributed within the NSW Stroke Network, and therefore should effectively capture all the operational stroke units in the region. Units that did not see a great throughput of patients were excluded. The approach to data collection is diligent with personal distribution of surveys and data collection by 2 researchers who did not influence respondents by comment or expression. Questionnaires were adequately described, using mainly close-ended questions of type 1) multiple-choice (with option for free-text), and 2) scaled questions.
Data was analysed using standard statistical methods. There was a high response rate which likely reflects the diligent survey distribution method. Data integrity was maintained by checking quality of responses and exclusion of survey responses that violated instructions.
In summary the results showed that most respondents preferred CSU as a model of care (doctors and allied health staff more than nurses). More respondents however felt that establishment of CSUs was not, or was unlikely to be feasible (only from non-CSUs; more from SU-R than SU-A). The most common barriers identified were space, money, staff and time. Perceived disadvantages were: inadequate staff training, bed management issues and work-related stress. Perceived advantages were: reduced patient transfers, earlier commencement of rehabilitation and improved patient satisfaction. There is no reference to individual comments or answers which may have provided a qualitative viewpoint.
The authors reasonably concluded that: 1) doctors and allied health staff favoured CSU more than nurses perhaps due to the formers’ emphasis on early rehabilitation and continuity of care, versus the latters’ concerns about mixing patients of different acuity; 2) reduced length of stay, improved functional outcomes and reduced morbidity and mortality were not perceived as prominent advantages of CSUs, perhaps reflecting respondents’ concerns that the model lacks emphasis on acute stroke care (possibly because of their lack of awareness of the evidence, or the evidence is regarded as inconclusive); 3) cost is a perceived barrier (although there is no published data regarding costs related to CSU establishment or maintenance compared to TSU); 4) rehabilitation appeared to commence earlier in CSUs compared to TSUs. Given this they suggest further research into establishment of CSUs is worthwhile.
Question 2: What is the significance of the article to leadership and management practice in health care organizations?
The key significance of this article to leadership and management practice in health care organizations pertains to the issue of transforming the model of inpatient stroke care for possibly better patient outcomes.
Lukas et al discuss 5 key elements in successful transformation of patient care, i.e. “1) Impetus...