Mackay Mark T, Churilov Leonid, Moon Anna, McKenzie Ian, Donnan Geoffrey A, Monagle Paul, Li Qi, Babl Franz E
Department of Neurology, Royal Children's Hospital, Parkville, Australia.
Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Australia.
Health Syst (Basingstoke). 2019 Sep 24;10(1):73-88. doi: 10.1080/20476965.2019.1664941.
Coordinated systems of care are required to improve access to reperfusion therapies in paediatric stroke. A conceptual model was developed to map the process-of-care from symptom onset to confirmation of diagnosis. Value-Focused Process Engineering with event-driven process modelling was used to identify barriers and enablers to timely and accurate paediatric stroke diagnosis. Stakeholder interviews were conducted to inform model design, development, demonstration and validation. Barriers included: (i) ambulance dispatcher failure to allocate high-priority response, (ii) childrens' exclusion from paramedic clinical practice guidelines, (ii) non-allocation of high triage category on hospital arrival, (iii) absence of emergency department guidelines for focal neurological deficits, and (iv) computed tomography as the first imaging investigation. Enablers included: (i) public awareness programs, (ii) childrens' inclusion in prehospital emergency stroke algorithms, (iii) re-organisation of health services, with primary paediatric stroke centres, (iv) implementation of triage and neuroimaging decision support tools, and (iv) rapid stroke MRI imaging protocols.
需要有协调的医疗系统来改善小儿中风患者获得再灌注治疗的机会。我们开发了一个概念模型来描绘从症状发作到确诊的护理过程。运用基于事件驱动过程建模的价值导向过程工程来确定及时准确诊断小儿中风的障碍和促进因素。进行了利益相关者访谈，以为模型的设计、开发、演示和验证提供信息。障碍包括：（i）救护车调度员未能分配高优先级响应；（ii）儿童被排除在护理人员临床实践指南之外；（ii）到达医院时未分配高分诊类别；（iii）急诊科缺乏针对局灶性神经功能缺损的指南；以及（iv）计算机断层扫描作为首次影像学检查。促进因素包括：（i）公众意识项目；（ii）将儿童纳入院前紧急中风算法；（iii）通过设立初级小儿中风中心来重组卫生服务；（iv）实施分诊和神经影像学决策支持工具；以及（iv）快速中风磁共振成像协议。
