建立综合性卒中单元的偏好、障碍和促进因素：一项多学科调查。

O'Rourke Fintan, Chan Daniel K Y, Chan Daniel L, Man Ding Xiao

Department of Aged Care, Stroke & Rehabilitation, Bankstown-Lidcombe Hospital, Bankstown, Australia. O'

Aust Health Rev. 2013 Jun;37(3):318-23. doi: 10.1071/AH12026.

OBJECTIVES

To determine the preferences of multidisciplinary stroke clinicians for models of inpatient stroke unit care and perceived barriers to establishing a comprehensive stroke unit (CSU) model (acute and rehabilitation care in the same ward).

METHODS

Written questionnaires distributed and completed at multidisciplinary stroke unit case conferences in NSW, Australia.

RESULTS

Twenty hospitals with 22 stroke units were surveyed, 13 acute stroke units, 7 rehabilitation stroke units, 2 CSUs. Two hundred and twenty-eight respondents: 99 (43.4%) allied health, 72 (31.6%) nurses and 57 (25.0%) doctors. One hundred and fifty-one respondents (67.0%) thought CSU to be the best model. Seventy-three % of doctors and 79% of allied health preferred CSU v. 57% of nurses (P=0.041). Of doctors, rehabilitation specialists were most likely to favour comprehensive model (84.2%) and neurologists least (57.0%). The main perceived advantages of CSU were reduced cost and improved functional outcomes; perceived disadvantages were increased workload and unwell patients unable to participate in rehabilitation. Main perceived barriers to establishing CSU were lack of space, money, staffing and time.

CONCLUSION

Although most current stroke unit care in NSW is based on the traditional model of acute and rehabilitation components in separate wards or hospitals, the majority of multidisciplinary stroke team clinicians believe CSU is the optimum model. What is known about the topic? Stroke unit care is known to improve survival and dependency but the optimum model of care is unproven, despite some small studies suggesting that the CSU model may result in better outcomes. What does this paper add? This paper is the first to survey stroke clinicians from various disciplines and types of unit, to determine their preferences for stroke unit model. What are the implications for practitioners? A majority of clinicians expressed a preference for the CSU model, suggesting that most would be comfortable caring for patients in both acute and rehabilitation phases of stroke care if further such units are established.

目的

确定多学科卒中临床医生对住院卒中单元护理模式的偏好，以及建立综合卒中单元（CSU，即在同一病房提供急性和康复护理）模式的感知障碍。

方法

在澳大利亚新南威尔士州的多学科卒中单元病例讨论会上分发并完成书面问卷。

结果

对设有22个卒中单元的20家医院进行了调查，其中13个急性卒中单元、7个康复卒中单元、2个综合卒中单元。共有228名受访者：99名（43.4%）为专职医疗人员，72名（31.6%）为护士，57名（25.0%）为医生。151名受访者（67.0%）认为综合卒中单元是最佳模式。73%的医生和79%的专职医疗人员更倾向于综合卒中单元，而护士中这一比例为57%（P=0.041）。在医生中，康复专科医生最有可能支持综合模式（84.2%），而神经科医生支持率最低（57.0%）。综合卒中单元的主要感知优势是成本降低和功能结局改善；感知劣势是工作量增加以及病情不适的患者无法参与康复。建立综合卒中单元的主要感知障碍是空间、资金、人员配备和时间不足。

结论

尽管新南威尔士州目前大多数卒中单元护理基于传统模式，即急性和康复部分分别设置在不同病房或医院，但多学科卒中团队的大多数临床医生认为综合卒中单元是最佳模式。关于该主题已知的情况是什么？已知卒中单元护理可提高生存率和改善依赖状况，但最佳护理模式尚未得到证实，尽管一些小型研究表明综合卒中单元模式可能会带来更好的结局。本文补充了什么内容？本文首次对来自不同学科和不同类型单元的卒中临床医生进行调查，以确定他们对卒中单元模式的偏好。对从业者有何启示？大多数临床医生表示倾向于综合卒中单元模式，这表明如果进一步建立此类单元，大多数人会愿意在卒中护理的急性和康复阶段照顾患者。