title: Implementation of evidence-based stroke care: enablers, barriers, and the role of facilitators.
abstract: A stroke care strategy was developed in 2007 to improve stroke services in Victoria, Australia. Eight stroke network facilitators (SNFs) were appointed in selected hospitals to enable the establishment of stroke units, develop thrombolysis services, and implement protocols. We aimed to explain the main issues being faced by clinicians in providing evidence-based stroke care, and to determine if the appointment of an SNF was perceived as an acceptable strategy to improve stroke care. Face-to-face semistructured interviews were used in a qualitative research design. Interview transcripts were verified by respondents prior to coding. Two researchers conducted thematic analysis of major themes and subthemes. Overall, 84 hospital staff participated in 33 interviews during 2008. The common factors found to impact on stroke care included staff and equipment availability, location of care, inconsistent use of clinical pathways, and professional beliefs. Other barriers included limited access to specialist clinicians and workload demands. The establishment of dedicated stroke units was considered essential to improve the quality of care. The SNF role was valued for identifying gaps in care and providing capacity to change clinical processes. This is the first large, qualitative multicenter study to describe issues associated with delivering high-quality stroke care and the potential benefits of SNFs to facilitate these improvements.
authors.affiliation: Translational Public Health Unit, Stroke and Ageing Research Centre, Department of Medicine, Monash Medical Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia ; Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia.
authors.forename: Tara
authors.initials: T
authors.lastname: Purvis
authors.affiliation: Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Moss
authors.affiliation: Commission for Hospital Improvement, Department of Health Victoria, VIC, Australia.
authors.forename: Sonia
authors.initials: S
authors.lastname: Denisenko
authors.affiliation: Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia ; Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Bladin
authors.affiliation: Translational Public Health Unit, Stroke and Ageing Research Centre, Department of Medicine, Monash Medical Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia ; Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia ; Department of Medicine, University of Melbourne, Parkville, VIC, Australia.
authors.forename: Dominique A
authors.initials: DA
authors.lastname: Cadilhac
keywords: clinical practice; facilitators; implementation; qualitative; stroke; stroke management