Identification of barriers and enablers to rapid diagnosis along the paediatric stroke chain of recovery using Value-Focused Process Engineering.
Paediatric Stroke Chain of Recovery
Stroke care systems
Value-Focused Process Engineering
child
conceptual modelling
stroke
Journal
Health systems (Basingstoke, England)
ISSN: 2047-6965
Titre abrégé: Health Syst (Basingstoke)
Pays: England
ID NLM: 101602681
Informations de publication
Date de publication:
24 Sep 2019
24 Sep 2019
Historique:
entrez:
24
3
2021
pubmed:
24
9
2019
medline:
24
9
2019
Statut:
epublish
Résumé
Coordinated systems of care are required to improve access to reperfusion therapies in paediatric stroke. A conceptual model was developed to map the process-of-care from symptom onset to confirmation of diagnosis. Value-Focused Process Engineering with event-driven process modelling was used to identify barriers and enablers to timely and accurate paediatric stroke diagnosis. Stakeholder interviews were conducted to inform model design, development, demonstration and validation. Barriers included: (i) ambulance dispatcher failure to allocate high-priority response, (ii) childrens' exclusion from paramedic clinical practice guidelines, (ii) non-allocation of high triage category on hospital arrival, (iii) absence of emergency department guidelines for focal neurological deficits, and (iv) computed tomography as the first imaging investigation. Enablers included: (i) public awareness programs, (ii) childrens' inclusion in prehospital emergency stroke algorithms, (iii) re-organisation of health services, with primary paediatric stroke centres, (iv) implementation of triage and neuroimaging decision support tools, and (iv) rapid stroke MRI imaging protocols.
Identifiants
pubmed: 33758658
doi: 10.1080/20476965.2019.1664941
pii: 1664941
pmc: PMC7946007
doi:
Types de publication
Journal Article
Langues
eng
Pagination
73-88Informations de copyright
© Operational Research Society 2019.
Déclaration de conflit d'intérêts
No potential conflict of interest was reported by the authors.
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