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

Conceptualising Centres of Clinical Excellence in Stroke Recovery and Rehabilitation: A Scoping Review (#152)

Thoshenthri Kandasamy 1 , Rachel C Stockley 2 , Jeroen M Hendriks 1 3 , Natalie A Fini 4 , Lemma N Bulto 1 , Elizabeth A Lynch 1
  1. Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
  2. Stroke Research Team. School of Nursing, University of Central Lancashire, Preston, UK
  3. Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
  4. Physiotherapy Department, School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia

Background: The International Stroke Recovery and Rehabilitation Alliance (ISRRA) highlighted a key theme for future research; the ‘development of a network of Clinical Centres of Excellence in Stroke Recovery’. Criteria to define and evaluate Centres of Clinical Excellence (CoCE) are necessary to create this network.

Aims: To map the available evidence about CoCEs, clarify the key definitions and identify currently existing CoCEs in Stroke Care.

Methods: A refined scoping review methodology was used. Databases were searched to identify relevant published studies since 2010.  Additionally, grey literature was searched using Google and Google Scholar. Literature with information about the definition of CoCEs; processes used to nominate, monitor or evaluate CoCEs; or frameworks used to establish CoCEs were included. A bespoke data charting form was developed to collate data on the features of each CoCE.

Results: In total, 5322 records were screened, and 47 records were included for analysis. No report described a CoCE in the field of stroke. Most literature about CoCEs was produced in the USA (n=26, 60%), based on one clinical condition or population. Definitions used to describe CoCEs were inconsistent, but common features included treating large numbers of patients, having highly skilled multi-disciplinary teams, and delivering high-quality care leading to the best patient outcomes. Processes used to select centres as CoCEs varied ranging from self-identification as a CoCE with no explicit criteria or external assessment, to application and assessment by an approval panel. Less than half the studies (n=25) reported on monitoring of care after facilities are identified as CoCE.

Conclusion: CoCEs are frequently defined by multi-disciplinary input, the concentration of expertise, quality of care and best patient outcomes. There are inconsistencies reported on how healthcare facilities are selected as CoCEs, and limited information on how CoCEs are monitored and evaluated. There was no literature reporting on CoCE in the field of stroke.