In order to coordinate the best possible treatment options for stroke patients a highly organised and streamlined pathway is needed, covering all aspects of stoke care, from initial screening to treatment. Stroke Units are one of the most efficient ways to do this.
Stroke Units are central to stroke care in most high-income countries, but many low- , middle- and emerging-high income countries do not have organised clinical stroke care pathways. In addition, despite there being many guidelines and protocols available for stroke care many of these have been developed in high-income countries and successful implementation of stroke care pathways in low- , middle- and emerging-high income countries can be challenging.
“While the guidelines are readily available, key barriers to the successful execution of stroke units in emerging high-, middle- and low- income can be: a lack of organised care systems, and a lack of resources and experience.” explains Dr. Urrutia, of The Johns Hopkins Hospital’s Comprehensive Stroke Center.
To overcome some of these barriers, the team at Pacífica Salud in Panamá led by Dr. Novarro-Escudero, came together to design and implement a Stroke Centre for its hospital in collaboration with, and under the mentorship of, The Johns Hopkins Hospital, Baltimore, USA.
In 2016 the process of developing a stroke program began. The collaboration saw the teams adapting guidelines for translating evidence into practice by Pronovost et al1 into 7 steps, which were then used to execute their programme. These were:
- Assessment of best practice and guidelines.
- Survey to establish current stroke care, resources and staff.
- Multidisciplinary stroke task force established across all departments involved in stroke care, to establish policies and procedures.
- Education programmes for all staff.
- Variables measuring quality of stroke programme established.
- Policies and procedures implemented and stroke programme formally launched.
- Continuation of multidisciplinary stroke task force. Progress and Quality Improvement was monitored.
“Since the development and implementation of the stroke programme at Pacífica Salud, year over year comparisons have shown an increase in the number of stroke patients treated and the number of acute interventions carried out.” said Dr. Urrutia.
The teams have attributed their success to the excellent collaborative efforts and believe the mentorship programme positively enhanced their accomplishments. “We believe this mentorship model is the way forward” explained Dr. Urrutia “we were able to overcome difficulties with translating evidence into practice through experience, teaching and education”.
- Pronovost PJ, Berenholtz SM, Needham DM. Translating evidence into practice: A 347 model for large scale knowledge translation. BMJ. 2008;337:a1714