Luker Julie A, Bernhardt Julie, Grimmer Karen A, Edwards Ian
International Centre for Allied Health Evidence, University of South Australia, GPO Box 2471, 5000 Adelaide, South Australia.
BMC Health Serv Res. 2014 Apr 29;14:193. doi: 10.1186/1472-6963-14-193.
Many patients with acute stroke do not receive recommended care in tertiary hospital settings. Allied health professionals have important roles within multidisciplinary stroke teams and influence the quality of care patients receive. Studies examining the role of allied health professionals in acute stroke management are scarce, and very little is known about the clinical decision making of these stroke clinicians. In this study we aimed to describe factors that influence the complex clinical decision making of these professionals as they prioritise acute stroke patients for recommended care. This qualitative study was part of a larger mixed methods study.
The qualitative methodology applied was a constructivist grounded theory approach.Fifteen allied health professionals working with acute stroke patients at three metropolitan tertiary care hospitals in South Australia were purposively sampled.Semi-structured interviews were conducted face to face using a question guide, and digital recording. Interviews were transcribed and analysed by two researchers using rigorous grounded theory processes.
Our analysis highlighted 'predicted discharge destination' as a powerful driver of care decisions and clinical prioritisation for this professional group. We found that complex clinical decision making to predict discharge destination required professionals to concurrently consider patient's pre-stroke status, the nature and severity of their stroke, the course of their recovery and multiple factors from within the healthcare system. The consequences of these decisions had potentially profound consequences for patients and sometimes led to professionals experiencing considerable uncertainty and stress.
Our qualitative enquiry provided new insights into the way allied health professionals make important clinical decisions for patients with acute stroke. This is the first known study to demonstrate that the subjective prediction of discharge destination made early in an acute admission by allied health professionals, has a powerful influence over the care and rehabilitation provided, and the ultimate outcomes for stroke patients.
许多急性中风患者在三级医院环境中未得到推荐的治疗。专职医疗人员在多学科中风团队中发挥着重要作用，并影响患者接受的护理质量。研究专职医疗人员在急性中风管理中作用的研究很少，对这些中风临床医生的临床决策了解甚少。在本研究中，我们旨在描述影响这些专业人员在将急性中风患者列为推荐治疗优先对象时复杂临床决策的因素。这项定性研究是一项更大的混合方法研究的一部分。
应用的定性方法是建构主义扎根理论方法。目的抽样选取了南澳大利亚州三家大都市三级护理医院中15名治疗急性中风患者的专职医疗人员。使用问题指南进行面对面的半结构化访谈，并进行数字录音。两名研究人员使用严格的扎根理论流程对访谈进行转录和分析。
我们的分析强调“预测出院目的地”是该专业群体护理决策和临床优先级的有力驱动因素。我们发现，预测出院目的地的复杂临床决策要求专业人员同时考虑患者中风前的状况、中风的性质和严重程度、恢复过程以及医疗系统内的多个因素。这些决策的后果可能对患者产生深远影响，有时会导致专业人员经历相当大的不确定性和压力。
我们的定性研究为专职医疗人员为急性中风患者做出重要临床决策的方式提供了新的见解。这是已知的第一项研究，表明专职医疗人员在急性入院早期对出院目的地的主观预测，对所提供的护理和康复以及中风患者的最终结局有强大影响。
