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Table 1 Implementation strategies to improve acute stroke care measures

From: A step toward understanding the mechanism of action of audit and feedback: a qualitative study of implementation strategies

Implementation strategy Definition of strategy Specification of strategy Outcomes affected
  Action Actor Action target Dose (frequency)  
1. Detailed stroke care protocols in the ED Provision of guidelines and instructions on how to implement stroke care readily available in ED Develop and disseminate stroke care protocols in the ED ED supervisor ED providers Ongoing Standardize stroke care, improve quality of care, reduce time to acute stroke treatment, guideline-concordant tPA use
2. Stroke care education and tPA competency training Education of staff on stroke protocols and guidelines and provision of interactive training on tPA administration In-person group training on stroke protocols and tPA administrate-on ED providers, nurse educators (doctors, nurses) ED providers (doctors, nurses) annual Improve quality of care via increased awareness and familiarity with stroke protocols and self-efficacy with tPA administration, guideline-concordant treatment
3. Modification of the timing of CT brain imaging in acute stroke care Taking the patient directly to the CT scanner upon hospital arrival Routing patient to the CT scanner immediately on arrival ED administrators ED providers Ongoing Reduce time to acute stroke treatment (door-to-needle time)
4. Increased access to tPA in the ED Storage of tPA in the ED Storing tPA in the automated dispensing cabinets in the ED Pharmacy ED nurse Ongoing Reduce time to acute stroke treatment
5. Additional staff to support implementation of acute stroke care protocols Supporting actions of ED staff during an acute stroke care protocol Supporting behavior of ED staff during an acute stroke care protocol and providing assistance when needed Stroke program manager, senior nurses, trauma nurse ED staff involved in acute stroke care protocol Ongoing Increase fidelity of implementation of acute stroke care protocols to improve quality of care, timeliness of tPA treatment
  1. ED emergency department, tPA tissue plasminogen activator, CT computed tomography
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Implementation Science

ISSN: 1748-5908

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