The Florey Institute (Austin Site), University of Melbourne, VIC, Australia (J.P.S., R.L.-S., J.B.).
La Trobe University, Bundoora Campus, Melbourne, VIC, Australia (J.P.S.).
Stroke. 2023 Nov;54(11):2946-2957. doi: 10.1161/STROKEAHA.123.044216. Epub 2023 Oct 17.
Stroke inpatient rehabilitation is a complex process involving stroke survivors, staff, and family utilizing a common space for a shared purpose: to optimize recovery. This complex pathway is rarely fully described. Stroke care is ideally guided by Clinical Practice Guidelines, and the rehabilitation built environment should serve to optimize care delivery, patient and staff experience. We aimed to articulate the inpatient stroke rehabilitation process of care in a series of process maps, and to understand the degree to which current stroke clinical and building construction (ie, design) guidelines align to support inpatient stroke rehabilitation.
We used the Value-Focused Process Engineering methodology to create maps describing the events and activities that typically occur in the current stroke inpatient rehabilitation service model. These maps were completed through individual and group session consultations with stroke survivors, architects, policy makers, and clinical experts. We then determined which sections of the Australian Stroke Rehabilitation Guidelines and the Australasian Health Facility Design Guidelines could be aligned and applied to the process maps.
We present a summary process map for stroke inpatient rehabilitation, alongside detailed process maps for 4 different phases of rehabilitation (admission, a normal weekday, a weekend day, and discharge) using Value-Focused Process Engineering notation. The integration of design and clinical guidelines with care pathway maps revealed where guidelines lack detail to be readily linked to current stroke inpatient care practice, providing an opportunity to design stroke inpatient rehabilitation spaces based on the activities occurring within them.
Our findings highlight gaps where clinical and design experts should work together to use guidelines to their full potential; and to improve the process of planning for future stroke rehabilitation units.
脑卒中住院康复是一个涉及脑卒中幸存者、工作人员和家属的复杂过程，他们利用共同的空间实现一个共同的目标：优化康复。然而，这个复杂的过程很少被完整描述。脑卒中护理理想情况下应由临床实践指南指导，康复建筑环境应有助于优化护理服务提供、患者和工作人员的体验。我们旨在通过一系列流程图阐明住院脑卒中康复护理过程，并了解当前脑卒中临床和建筑设计（即设计）指南在多大程度上支持住院脑卒中康复。
我们使用注重价值的流程工程方法创建了描述当前脑卒中住院康复服务模型中通常发生的事件和活动的流程图。这些流程图是通过与脑卒中幸存者、建筑师、政策制定者和临床专家的个人和小组会议咨询完成的。然后，我们确定了澳大利亚脑卒中康复指南和澳大拉西亚医疗设施设计指南中的哪些部分可以与流程映射对齐并应用。
我们展示了脑卒中住院康复的总结流程图，以及康复 4 个不同阶段（入院、正常工作日、周末和出院）的详细流程图，使用注重价值的流程工程符号表示。将设计和临床指南与护理路径图整合，揭示了指南缺乏与当前脑卒中住院护理实践直接相关的细节的地方，为基于其中发生的活动设计脑卒中住院康复空间提供了机会。
我们的发现强调了临床和设计专家应该共同努力的领域，以充分利用指南，并改善未来脑卒中康复单元的规划过程。
