Paul Christine, D'Este Catherine, Ryan Annika, Jayakody Amanda, Attia John, Oldmeadow Christopher, Kerr Erin, Henskens Frans, Grady Alice, Levi Christopher R
School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.
Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia.
SAGE Open Med. 2019 Jul 21;7:2050312119865656. doi: 10.1177/2050312119865656. eCollection 2019.
Intravenous thrombolysis is one of few evidence-based treatments for acute stroke. Treatment uptake is low outside major stroke care centres. There is a need for greater understanding of barriers encountered by clinicians when seeking to increase thrombolysis rates.
The aim of this study is to describe physicians' and nurses' perceptions regarding thrombolysis for acute stroke at hospitals in the earlier stages of thrombolysis implementation.
A cross-sectional paper survey completed by physicians' and nurses' was distributed to 1127 staff at stroke care units, emergency departments or equivalent stroke care facilities at 19 Australian hospitals, as part of a cluster randomised controlled trial for thrombolysis implementation and systems improvement.
Of 1127 potential participants, 503 (148 physicians and 355 nurses) completed surveys (45% response rate). Over 90% agreed that thrombolysis improved the odds of independent survival. However, 42% to 58% agreed that there were limitations in the evidence base. A small proportion of staff indicated deficits in technical competencies. Interactive or competency-based training was reported by less than two-thirds of the sample. Challenges such as quick bed availability were identified. Emergency department physicians were less positive towards the treatment compared with nurses (p < 0.001), stroke care unit physicians were more positive than nurses (p = 0.047) and older clinicians were more positive than younger clinicians (p = 0.007).
Australian hospitals seeking to address barriers to stroke thrombolysis implementation may benefit from the availability of interactive and competency-based training, staff performance feedback, support to make beds available quickly and bypass arrangements to quickly deliver acute stroke patients to appropriate facilities.
静脉溶栓是少数经循证的急性卒中治疗方法之一。在大型卒中护理中心之外，治疗的采用率较低。需要更深入了解临床医生在试图提高溶栓率时遇到的障碍。
本研究的目的是描述在溶栓实施早期阶段，医院内科医生和护士对急性卒中溶栓治疗的看法。
作为一项关于溶栓实施和系统改进的整群随机对照试验的一部分，向澳大利亚19家医院的卒中护理单元、急诊科或同等卒中护理设施的1127名工作人员发放了一份由内科医生和护士填写的横断面纸质调查问卷。
在1127名潜在参与者中，503人（148名内科医生和355名护士）完成了调查（回复率为45%）。超过90%的人认为溶栓提高了独立生存的几率。然而，42%至58%的人认为循证依据存在局限性。一小部分工作人员表示技术能力存在不足。不到三分之二的样本报告接受过互动式或基于能力的培训。确定了诸如快速提供床位等挑战。与护士相比，急诊科医生对该治疗的积极性较低（p<0.001），卒中护理单元的内科医生比护士更积极（p=0.047），年长的临床医生比年轻的临床医生更积极（p=0.007）。
寻求解决卒中溶栓实施障碍的澳大利亚医院，可能会受益于提供互动式和基于能力的培训、工作人员绩效反馈、支持快速提供床位以及制定将急性卒中患者快速转运至合适设施的旁路安排。
