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Emergency department stroke and transient ischaemic attack care bundle

Background

Improving the management of acute stroke and transient ischaemic attack (TIA) in the emergency department (ED) was identified as a priority by the NICS Emergency Care Community of Practice (EC CoP).

In response, NICS initiated a project to develop a set of evidence-based resources to improve the implementation of guideline recommendations for acute stroke and TIA management in the ED.

The project used the National Stroke Foundation’s (NSF) Clinical Guidelines for Acute Stroke Management (2007), available from the NSF website, as the evidence-base for the resources. In addition to the NSF guidelines, another nine relevant, evidence-based guidelines were used to develop the ‘guideline summaries’ that are included in the resource.

Given the ED setting and the varied requirements of acute stroke management, a care bundle approach was selected to prioritise the core relevant NSF recommendations for implementation.

What is a care bundle?

A care bundle is defined as a group of several simple, specific but non-prescriptive, evidence based components that, when combined, define best care and significantly improve patient outcomes. Please see the Information and implementation package for more information about care bundles.

According to the Institute for Healthcare Improvement, developers of the care bundle concept, for a care bundle to be effective, each component included in a bundle must also satisfy the following criteria:

  • each component must be based on sound evidence
  • the delivery of each component must be in need of improvement
  • to deliver each component must be achievable in terms of resources
  • no component should be a major source of controversy
  • and the delivery of each component must be measurable

The care bundle approach is designed to be easily achievable and sustainable both to implement and to audit.

Emergency Department Stroke and TIA Care Bundle resources

Information and implementation package A comprehensive master document, developed to fully explain the care bundle itself and provide implementation information. This document has been designed for the individual implementing the care bundle in their organisation (the project lead) and therefore aims to be comprehensive, but still practical.

Summary for clinicians

A summary document which includes all the necessary and practical information taken from the Implementation and information package.
Poster An A3 format poster for use in the emergency department as a reminder to staff.
Education Presentation A PowerPoint presentation developed to be used by the project lead as part of implementation of the care bundle.

These resources are available for order or download via the link below.

Endorsing agencies

Evaluation

In 2010 an evaluation strategy was designed to investigate the appropriateness and effectiveness of the ED Stroke and TIA Care Bundle format and dissemination strategy.

The aim of this evaluation was to investigate:

  • The impact of disseminating the care bundle to 155 emergency departments.
  • The effectiveness of the care bundle format to improve the uptake of guideline recommendations.
  • Any changes in clinical practice.

Evaluation findings include:

  • Strong support for this care bundle as a practical resource to assist with implementation of guideline recommendations.
  • The importance of reminders following the initial dissemination of tools or resources to promote their availability and value to the sector.

The evaluation findings are intended to inform emergency clinicians, managers, agencies involved in the implementation of guidelines and those with an interest in research translation methods. An Executive Summary has been provided below.

Page reviewed: 8 January, 2013