Platform Presentation The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Interventions to Improve the Delivery of Evidence-Based Practices in Acute Stroke Units – a Cochrane Systematic Review (#8)

Elizabeth A Lynch 1 , Lemma Bulto 1 , Heilok Cheng 2 , Louise Craig 3 , Julie Luker 4 , Kathleen Bagot 5 , Tharshanah Thayabaranathan 6 , Heidi Janssen 7 , Liz McInnes 2 , Sandy Middleton 2 , Dominique A Cadilhac 6
  1. Flinders University, Bedford Park, SA, Australia
  2. Australian Catholic University, Sydney
  3. University of Glasgow, Glasgow
  4. University of South Australia, Adelaide
  5. Florey Institute of Neuroscience and Mental Health, Melbourne
  6. Monash University, Melbourne
  7. University of Newcastle, Newcastle

Background

The delivery of evidence-based practices by health professionals in acute stroke units is inconsistent.

Aims

To assess the effect of implementation interventions on adherence to evidence-based practices in acute stroke units.

Methods

Systematic review using Cochrane methodology. Participants were health professionals providing care to patients in acute stroke units; implementation interventions were compared to no intervention or another implementation intervention. Two authors independently selected studies for inclusion, extracted data and assessed risk of bias and certainty of evidence using GRADE.

Results 

Seven cluster-randomised trials (23,460 patient participants from 129 hospitals) were included, conducted in Australia, the United Kingdom, China, and the Netherlands. Health professional participants were nursing, medical and allied health professionals.

Five trials compared multifaceted implementation interventions to no intervention, two trials compared different multifaceted implementation interventions.

There is uncertainty whether multifaceted implementation interventions lead to changes in delivery of evidence-based practices compared with no intervention (Risk ratio [RR] 1.73; 95% CI 0.83-3.61; very low certainty evidence). There is moderate certainty evidence that multifaceted implementation interventions compared to no intervention lead to little/no difference in the proportion of patients with ischaemic stroke who received thrombolysis (RR 1.14, 95% CI 0.94-1.37) or in reducing the risk of death, disability or dependency (RR 0.93, 95% CI 0.85-1.02); but probably increase the proportion of patients with ischaemic stroke treated with thrombolysis who are admitted within 4-hours of symptom onset (adjusted MD 1.58%, 95% CI 1.11-2.27) and the proportion of patients who receive a swallow screen within 24-hours of admission (RR 6.76, 95% CI 4.44-10.76).

The two trials that compared different multifaceted implementation interventions were too disparate to warrant meta-analysis. 

Conclusion 

The certainty of evidence regarding the effect of implementation interventions on the delivery of evidence-based practices in acute stroke units is very low. Future well-conducted studies will have an important impact on the effect estimate and our confidence in the findings.