| Methods |
Before‐and‐after study with one concurrent control group (patients admitted to general medical wards). Mixed prospective and retrospective data collection. |
| Participants |
439 patients with stroke and TIA ‐ CP group 197, 'before' group 154, and GMW group 88. |
| Interventions |
TREATMENT GROUP: integrated care pathway for use in an acute stroke unit from July 2000 to April 2001. CP document was a multidisciplinary patient record developed by stroke team to guide patient care during first five days of admission. CP consisted of check‐lists and comprised three sections ‐ doctors', nurses', and therapists' sections. On admission, initial assessments were guided by doctor's clerking proforma, nursing and therapy assessment forms, and various assessment tools. Staff followed treatment algorithms to guide acute stroke care including management of common medical problems (e.g. fever, hypoxia). Patients' goals and progress discussed at weekly MDT meeting.
CONTROL GROUP: usual care within the same acute stroke unit was identical to CP group except the use of the CP. One extra physiotherapist was employed between the two study periods. GMW GROUP: stroke care provided by medical consultants and nursing staff in general medical wards. Same therapists worked in acute stroke unit. No CP, stroke protocol, or multidisciplinary record. Access to rehabilitation and neuroimaging same as CP group. |
| Outcomes |
Mean LOS (days): CP=13.4+/‐15.1 vs Before=13.8+/‐19.7 vs GMW=13.6+/‐23.4. Death by day 5: CP=11/197 vs Before=9/154 vs GMW=7/88. Death in hospital: CP=25/197 vs Before=20/154 vs GMW=9/88. Discharge to institution: CP=69/197 vs Before=56/154 vs GMW=25/88. Discharge to home: CP=103/197 vs Before=78/154 vs GMW=54/88. Dependency (mRS>2) on day 5: CP=108/123 vs GMW=35/42.
COMPLICATIONS IN FIRST 5 DAYS: Pneumonia: CP=21/197 vs Before=16/154 vs GMW=8/88. UTI: CP=10/197 vs Before=15/154 vs GMW=5/88. Pressure sore: CP=5/197 vs Before=4/154 vs GMW=2/88. DVT: CP=2/197 vs Before=0/154 vs GMW=0/88. Falls: CP=19/197 vs Before=12/154 vs GMW=5/88. Fever: CP=46/197 vs Before=42/154 vs GMW=26/88. Constipation: CP=24/197 vs Before=25/154 vs GMW=9/88. Seizures: CP=7/197 vs Before=5/154 vs GMW=4/88. Any complication: CP=102/197 vs Before=92/154 vs GMW=44/88. TESTS: Total CT scan: CP=189/197 vs Before=143/154 vs GMW=82/88. CT <24hr: CP=163/197 vs Before=111/154 vs GMW=66/88. Carotid duplex: CP=96/197 vs Before=80/154 vs GMW=45/88. ECG: CP=192/197 vs Before=152/154 vs GMW=78/88. Echo: CP=55/197 vs Before=32/154 vs GMW=34/88. Cerebral angiogram/MRA: CP=2/197 vs Before=2/154 vs GMW1/88. CXR: CP=95/197 vs Before=104/154 vs GMW=42/88. DRUGS: Aspirin <48hr: CP=133/175 vs Before=101/133 vs GMW=55/78. Subcutaneous heparin: CP=6/197 vs Before=5/154 vs GMW=5/88. IV heparin: CP=1/197 vs Before=5/154 vs GMW=0/88. Oral antibiotics: CP=17/197 vs Before=16/154 vs GMW=10/88. IV antibiotics: CP=24/197 vs Before=9/154 vs GMW=13/88. IV fluids: CP=81/197 vs Before=65/154 vs GMW=26/88. Acute antihypertensive therapy: CP=6/197 vs Before=8/154 vs GMW=8/88. OTHERS: Urine catheters (for incontinent patients): CP=37/91 vs Before=30/64 vs GMW=21/29. TEDS: CP=9/197 vs Before=10/154 vs GMW=11/88. Compared to the 'before' and GMW groups, documentation was better in CP group for: 1) certain aspects of neurological assessment; and 2) anatomical site of the brain lesion and its pathologial type. |
| Notes |
Acute stroke. Both groups similar except . CP group had more total anterior circulation strokes (29% vs 18%, p=0.005). No data on costs. Compliance generally good in terms of use of CP document and level of completeness. |
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Allocation concealment? |
Unclear risk |
D ‐ Not used |
