Šedová Petra, Líčeník Radim, Ismail Tahir, Khaled Hasan Muhammad, Klugar Miloslav, Riad Abanoub, Klugarová Jitka
Department of Neurology, St Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
International Clinical Research Centre, Stroke Research Program, St Anne's University Hospital, Brno, Czech Republic.
JBI Evid Implement. 2025 Jan 1;23(S1):S27-S34. doi: 10.1097/XEB.0000000000000497.
This evidence implementation project aimed to assess and improve compliance with evidence-based neuroimaging criteria for adult patients with suspected stroke.
Stroke is the second leading cause of mortality and severe disability, requiring timely and accurate diagnosis. Clinical guidelines recommend brain imaging within 60 minutes of hospital arrival for suspected stroke patients. This project involved hospitals in North West Anglia NHS Foundation Trust, UK, serving 850,000 people with over 800 admissions annually.
The JBI Evidence Implementation Framework was used to guide this project. JBI software, the Practical Application of Clinical Evidence System (PACES), as well as JBI's Getting Research into Practice (GRiP) approach, were used to conduct the audit and implementation phases. The project followed three stages: (1) implementation planning, (2) baseline assessment and implementation, and (3) impact evaluation. Three audit criteria were used to represent best practices for diagnosing suspected stroke patients.
The baseline audit revealed low compliance with the first criterion, with only 2.9% (1/35) of patients receiving a CT head scan within 1 hour of admission. In the follow-up audit, compliance improved to 45.2% (14/31). The other two criteria, diagnosis by a trained health care professional and baseline ECG assessment, had already achieved 100% compliance in the baseline audit.
Compliance with evidence-based neuroimaging criteria improved after implementing targeted educational strategies and training. The rate of CT scans conducted within 1 hour increased, although door-to-imaging times remain suboptimal compared with achievable benchmarks of ≤ 20 minutes. Ongoing education and training are crucial for sustaining high compliance and improving stroke patient outcomes.
本循证实施项目旨在评估并提高成年疑似中风患者对循证神经影像学标准的依从性。
中风是导致死亡和严重残疾的第二大主要原因，需要及时准确的诊断。临床指南建议疑似中风患者在入院后60分钟内进行脑部成像检查。该项目涉及英国西北安格利亚国民保健服务基金会信托基金旗下的医院，服务85万人，每年入院人数超过800人。
采用JBI循证实施框架指导本项目。使用JBI软件、临床证据系统的实际应用（PACES）以及JBI的将研究转化为实践（GRiP）方法来进行审核和实施阶段。该项目遵循三个阶段：（1）实施规划，（2）基线评估与实施，以及（3）影响评估。使用三项审核标准来代表诊断疑似中风患者的最佳实践。
基线审核显示对第一项标准的依从性较低，只有2.9%（1/35）的患者在入院后1小时内接受了头部CT扫描。在后续审核中，依从性提高到了45.2%（14/31）。其他两项标准，即由经过培训的医疗保健专业人员进行诊断和基线心电图评估，在基线审核中已达到100%的依从性。
实施有针对性的教育策略和培训后，对循证神经影像学标准的依从性有所提高。1小时内进行CT扫描的比例有所增加，尽管从入院到成像的时间与≤20分钟的可实现基准相比仍不理想。持续的教育和培训对于维持高依从性和改善中风患者的预后至关重要。
