Author, Year |
State, Country |
Clinical Setting |
Organisation of care |
Baker 1998 |
Indianapolis, USA |
Acute stroke |
Patients were cared for in a neurology/orthopaedic ward in a community hospital. Stroke patients were screened according to specific guidleines for suitability for case management using a clinical pathway. Clinical pathway was also evaluated by variance analysis. A 2‐year pilot study was undertaken after implementation |
Bowen 1994 |
Washington, USA |
Acute stroke |
Unclear what type of ward in which patients in either group were cared for, but mostly likely acute general internal medical ward within an urban community hospital. Nurse initiated stroke protocol on admission, starting with algorithm at the emergency department and continued to the hospital unit with standard order sheets and protocol. Protocol was approved by specialists and primary care physicians. Resident doctors received specific education on stroke protocol. Stroke protocol was introduced as a method for cost‐containment |
Crawley 1996 |
Georgia, USA |
Acute stroke and rehabilitation |
Patients were cared for in a neurosciences unit in a teaching hospital. Case management using a criical path was developed by a multidiscplinary team and managed by a case manager (an assistant head‐nurse), who followed the patient from admission to discharge. Critical path was also evaluated by variance analysis |
Falconer 1993 |
Illinois, USA |
Stroke rehabilitation |
Unclear what type of ward in which patients in either group were initially cared for (a general medical ward or acute stroke unit), but patients were transferred to a rehabilitation unit in a specialised rehabilitation institute. Leader of the multidisciplinary team was the physician. A critical path (and the ideal length of stay) was generated by the computer according the therapy required |
Hamrin 1990 |
Linkoping, Sweden |
Acute stroke and rehabilitation |
Patients were cared for in a general internal medical ward in a teaching hospital. Numbers of nursing staff and therapists were similar in both groups. The project group was involved in multidisciplinary team meetings, educational meetings and communication with primary care team. |
Kwan 2004 |
Edinburgh, UK |
Acute stroke |
Patients were managed on the acute stroke unit which was a 10‐bedded unit situated within a 25‐bedded elderly care ward. Medical cover was provided by two stroke specialist consultants, one senior and one junior medical officer. The nurse‐to‐bed ratio was between 0.15 (night shift) to 0.27 (early shift). Rehabilitative therapy was provided by 1.5 whole time equivalent (WTE) physiotherapist, 1.5 WTE occupational therapist, 0.5 WTE speech therapist, a dietician and a social worker. Patients' progress was discussed at the weekly multidisciplinary team meetings. The care pathway was developed by the stroke team to guide patient care during the first five days of admission. The development process consisted of review of research evidence and clinical guidelines, design of the ICP document, and its implementation on the unit with training sessions for the staff. |
Mosimaneotsile 2000 |
Hawaii, USA |
Stroke rehabilitation |
Patients were cared for in a 100‐bedded private rehabilitation unit which catered for all types of patients including stroke. Multidisciplnary assessment was performed within 24 hours of admission. Reports of the assessments then guided treatment, goal‐setting and discharge planning. Regular multidisciplinary team conferences were conducted to discuss the patient's goals and progress. |
Odderson 1993 |
Washington, USA |
Acute stroke |
Unclear what type of ward in which patients in either group were cared for, but mostly likely a rehabilitation ward within an urban community hospital. Care pathway was developed by teams of physicians and professions allied to medicine, with specific inclusion and exclusion criteria. Patient care followed specific guidelines (e.g. deep vein thrombosis prevention, artificial feeding, bowel programme). Medicare was introduced in 1982 and prospective payment system in 1983 ‐ hospital was asked to reduce length of stay for certain conditions such as stroke |
Pasquarello 1990 |
Texas, USA |
Acute stroke |
Unclear what type of ward in which patients in either group were cared for, but mostly likely a general internal medical ward within a teaching hospital. Patients in the stroke programme were exclusively managed by a clinical nurse specialist (CNS). Patient education was provided by weekly group meetings (stroke recovery group) for 45 minutes. CNS was also involved in post‐discharge care, outpatient program and nursing education |
Ross 1997 |
Michigan, USA |
Acute stroke |
Unclear what type of ward in which patients in either group were cared for, but mostly likely a general internal medical ward within a community hospital. Critical pathway was developed by multidisciplinary task force and consisted of specific protocols (e.g. telemetry, carotid duplex <24 hours, two CT scans) and pre‐defined outcome measures and items for variance analysis. There was pre‐implementation education program for every discipline |
Schull 1992 |
Texas, USA |
Acute stroke and rehabilitation |
Patients were cared for in a neurology ward within a teaching hospital. There was a clinical nurse specialist as case manager. Case management was introduced as a cost‐containment tool |
Sulch 2000 |
London, UK |
Stroke rehabilitation |
Unclear what type of ward in which patients in either group were initially cared for (a general medical ward or acute stroke unit), but after randomisation, patients were transferred to a stroke rehabilitation unit within a teaching hospital. Care pathway was developed by a multidisciplinary group and implemented by an experienced nurse. There were special training sessions and a 3‐month pilot study |
Wee 200 |
Mississippi, USA |
Acute stroke and rehabilitation |
Unclear what type of ward in which patients in either group were cared for, but mostly likely a mixture of neurology and general internal medical ward within a community hospital. Organisation of care was poorly described. Clinical pathway was designed by the stroke team and approved by medical care committee. No care manager was employed. |
Widjaja 2002 |
Singapore |
Acute stroke and rehabilitation |
Organsation of care was poorly described. Stroke pathway was designed by the multidisciplinary team. |
Wilkinson 2000 |
Brisbane, Australia |
Acute stroke |
Patients were managed in a stroke unit within a district general hospital. Stroke pathway project was led by a geriatrician and pathway designed by a multidisciplinary team. The project also included opening of a new acute stroke unit and acquisition of new equipment. Implementation of the pathway involved focus groups, team meetings, visits to other hospital units, audits, and educational sessions for the healthcare staff. |