Implementation of an Advanced Practice Registered Nurse-Led Clinic to Improve Follow-up Care for Post-Ischemic Stroke Patients

Timing of stroke survivors' hospital readmissions to guide APRNs in primary care

BACKGROUND

Caring for patients after a neurovascular incident is common for advanced practice registered nurses (APRNs). Most neurological readmission studies focus on a small subset of neurovascular incident groups, but advanced practice nurses in primary care attend to a diverse neurovascular population and lack time to adequately search hospital records.

PURPOSE

The aim of this study was to determine readmission risk factors after a neurovascular incident to guide APRNs in the primary care setting.

METHODOLOGY

The study is a retrospective observational study that used a crude single predictor model to determine potential risks for readmission.

RESULTS

A total of 876 neurovascular participants were studied. Of these, only 317 experienced at least one hospital readmission, with 703 readmissions within 1 year, indicating some were readmitted more than once. Risks for readmission varied across neurovascular events. The main reasons for readmission were because of neurological, cardiovascular, and musculoskeletal complications.

CONCLUSIONS

Stroke readmission rates are high and require intervention by APRNs. To prevent readmission includes timely follow-up within 30 days and should also include longitudinal follow-up beyond 90 days to prevent hospital readmission.

IMPLICATIONS

Future studies are needed to create guidelines for APRNs that implement rehabilitation strategies to decrease hospital readmission for the neurovascular population that focus on interdisciplinary communication.

A scoping review of hospital to home transitional care programmes for stroke survivors

AIM

The study was aimed at exploring the current scope of hospital to home transitional care programmes for stroke survivors.

BACKGROUND

Stroke survivors face the dilemma of solving many complex problems that leave survivors at high risk for readmission as they discharge from hospital. The transitional care model has proved to be effective in reducing readmissions and mortality, thereby improving health outcomes and enhancing patient satisfaction for survivors with stroke.

DESIGN

A scoping review.

METHODS

Conducted in accordance with the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews.

DATA SOURCES

A comprehensive search was conducted in nine databases, including PubMed, Web of Science, Cochrane Library, EMBASE, CINAHL, Medline, China Knowledge Net-work, Wanfang Database and China Biomedical Literature Database (SinoMed) from January 2014 to June 2023.

RESULTS

Title and abstract screening was performed on 10,171 articles resulting in 287 articles for full-text screening. Full-text screening yielded 49 articles that met inclusion criteria.

CONCLUSION

This study identified transitional care programmes for stroke survivors, as well as areas for future consideration to be explored in more depth to help improve transitional care for stroke survivors as they transition from hospital to home.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This study demonstrates that multidisciplinary collaboration becomes an integral part of the transitional care model for stroke survivors, which provides comprehensive and precise medical care to them.

REPORTING METHOD

PRISMA checklist for scoping reviews.

PATIENT AND PUBLIC CONTRIBUTION

No patient or public contribution was part of this study.

Practice patterns, role and impact of advanced practice nurses in stroke care: A mixed-methods systematic review

AIM(S)

To undertake a systematic review of the practice patterns and roles of advanced practice nurses (APNs) in inpatient and outpatient stroke-care services; and to evaluate the impact of APN-led inpatient and outpatient stroke-care services on clinical and patient-reported outcomes.

DESIGN

A mixed-methods systematic review.

METHODS

A systematic search was conducted across six electronic databases for primary studies. Data were synthesised using a convergent integrated approach. DATA SOURCES (INCLUDE SEARCH DATES) *FOR REVIEWS ONLY: A systematic search was conducted across PubMed, CINAHL, Cochrane Library, Embase, PsycInfo and ProQuest Dissertations & Theses Global, for primary studies published between the inception of the databases and 3 November 2022.

RESULTS

Findings based on the 18 included primary studies indicate that the APNs' roles have been implemented across the continuum of stroke care, including pre-intervention care, inpatient care and post-discharge care. Practicing at an advanced level, the APNs engaged in clinical, operational and educational undertakings across services and disciplines. Positive clinical and patient-reported outcomes have been attributed to their practice.

CONCLUSION

The review highlights the critical role of APNs in improving stroke care, especially in the pre-intervention phase. Their clinical expertise, patient-centered approach and collaboration can transform stroke care. Integrating APNs into stroke care teams is essential for better management and outcomes in light of the increasing stroke burden.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Healthcare institutions should integrate APNs to enhance pre-intervention stroke care, improve diagnostic accuracy and expedite treatment. APNs can prioritise patient-centric care, including assessments, coordination and education. Medication reconciliation, timely rehabilitation referrals and lifestyle modifications for secondary stroke prevention are crucial. Implementing advanced practice nursing frameworks ensures successful APN integration, leading to improved stroke care and better patient outcomes in response to the growing stroke burden.

IMPACT (ADDRESSING)

What problem did the study address? Poor clarity of the role of advanced practice nurses among patients, physicians, healthcare professionals, health policymakers and nurses. What were the main findings? Advanced practice nurses practise across the continuum of stroke care, mainly in pre-intervention care which takes place before initiating treatment, inpatient care and post-discharge care. The implementation of the advanced practice nurse role in stroke care has contributed positively to clinical and patient-reported outcomes. Where and on whom will the research have an impact? Insights from the review are envisioned to inform healthcare policymakers and leaders in the implementation and evaluation of the APN role in stroke care.

REPORTING METHOD

Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution. TRIAL AND PROTOCOL REGISTRATION: https://figshare.com/ndownloader/files/41606781; Registered on Open Science Framework osf.io/dav8j.