The challenges of implementing a telestroke network: a systematic review and case study

BMC Medical Informatics and Decision Making

Research Article

Mark O’Donnell¹  Elaine Day²  Gary Ford³  Alison McLoughlin⁴  Hedley Emsley⁴  Damian Jenkinson⁵  Paul Davies⁶  Michael Leathley⁷  Catherine Lightbody⁷  Christopher Sutton⁷  Beverley French⁷  Jane Fitzgerald⁷  Caroline Watkins⁷  Carl May⁸  Christopher Price⁹ 

[1] Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool Victoria Hospital, Blackpool, UK;Cardiac and Stroke Networks Lancashire and Cumbria, Preston, UK;Institute for Ageing and Health, Newcastle University, Royal Victoria Infirmary, Newcastle, UK;Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK;NHS Improvement – Stroke, St John’s House, East Street, Leicester, UK;North Cumbria University Hospitals NHS Trust, The Cumberland Royal Infirmary, Carlisle, UK;University of Central Lancashire, Preston, UK;University of Southampton, Faculty of Health Sciences, Southampton, UK;Wansbeck General Hospital, Ashington, Northumberland, UK;

关键词: Normalisation Process Theory;    Acute Stroke Care;    Implementation Task;    Stroke Physician;    Implementation Resource;   

DOI  :  10.1186/1472-6947-13-125

 received in 2013-07-19, accepted in 2013-11-13,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundThe use of telemedicine in acute stroke care can facilitate rapid access to treatment, but the work required to embed any new technology into routine practice is often hidden, and can be challenging. We aimed to collate recommendations and resources to support telestroke implementation.MethodsSystematic search of healthcare databases and the Internet to identify descriptions of the implementation of telestroke projects; interviews with key stakeholders during the development of one UK telestroke network. Supporting documentation from existing projects was analysed to construct a framework of implementation stages and tasks, and a toolkit of documents. Interviews and literature were analysed with other data sources using Normalisation Process Theory as described in the e-Health Implementation Toolkit.Results61 telestroke projects were identified and contacted. Twenty projects provided documents, 13 with published research detailing four stages of telestroke system development, implementation, use, and evaluation. Interviewees identified four main challenges: engaging and maintaining the commitment of a wide range of stakeholders across multiple organisations; addressing clinicians perceptions of evidence, workload, and payback; managing clinical and technical workability across diverse settings; and monitoring how the system is used and reconfigured by users.ConclusionsInformation to guide telestroke implementation is sparse, but available. By using multiple sources of data, sufficient information was collated to construct a web-based toolkit detailing implementation tasks, resources and challenges in the development of a telestroke system for assessment and thrombolysis delivery in acute care. The toolkit is freely available online.

【 授权许可】

CC BY   
© French et al.; licensee BioMed Central Ltd. 2013