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Implementation Science
Published in: Implementation Science 1/2019

Open Access 01-12-2019 | Stroke | Research

Can a multicomponent multidisciplinary implementation package change physicians’ and nurses’ perceptions and practices regarding thrombolysis for acute ischemic stroke? An exploratory analysis of a cluster-randomized trial

Authors: Md Golam Hasnain, Christopher R. Levi, Annika Ryan, Isobel J. Hubbard, Alix Hall, Christopher Oldmeadow, Alice Grady, Amanda Jayakody, John R. Attia, Christine L. Paul

Published in: Implementation Science | Issue 1/2019

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Abstract

Background

The Thrombolysis ImPlementation in Stroke (TIPS) trial tested the effect of a multicomponent, multidisciplinary, collaborative intervention designed to increase the rates of intravenous thrombolysis via a cluster randomized controlled trial at 20 Australian hospitals (ten intervention, ten control). This sub-study investigated changes in self-reported perceptions and practices of physicians and nurses working in acute stroke care at the participating hospitals.

Methods

A survey with 74 statements was administered during the pre- and post-intervention periods to staff at 19 of the 20 hospitals. An exploratory factor analysis identified the structure of the survey items and linear mixed modeling was applied to the final survey domain scores to explore the differences between groups over time.

Result

The response rate was 45% for both the pre- (503 out of 1127 eligible staff from 19 hospitals) and post-intervention (414 out of 919 eligible staff from 18 hospitals) period. Four survey domains were identified: (1) hospital performance indicators, feedback, and training; (2) personal perceptions about thrombolysis evidence and implementation; (3) personal stroke skills and hospital stroke care policies; and (4) emergency and ambulance procedures. There was a significant pre- to post-intervention mean increase (0.21 95% CI 0.09; 0.34; p < 0.01) in scores relating to hospital performance indicators, feedback, and training; for the intervention hospitals compared to control hospitals. There was a corresponding increase in mean scores regarding perceptions about the thrombolysis evidence and implementation (0.21, 95% CI 0.06; 0.36; p < 0.05). Sub-group analysis indicated that the improvements were restricted to nurses’ responses.

Conclusion

TIPS resulted in changes in some aspects of nurses’ perceptions relating to the evidence for intravenous thrombolysis and its implementation and hospital performance indicators, feedback, and training. However, there is a need to explore further strategies for influencing the views of physicians given limited statistical power in the physician sample.

Trial registration

ACTRN12613000939​796, UTN: U1111–1145-6762.
Appendix
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Metadata
Title
Can a multicomponent multidisciplinary implementation package change physicians’ and nurses’ perceptions and practices regarding thrombolysis for acute ischemic stroke? An exploratory analysis of a cluster-randomized trial
Authors
Md Golam Hasnain
Christopher R. Levi
Annika Ryan
Isobel J. Hubbard
Alix Hall
Christopher Oldmeadow
Alice Grady
Amanda Jayakody
John R. Attia
Christine L. Paul
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Stroke
Published in
Implementation Science / Issue 1/2019
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-019-0940-0

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