Adherence to Ischemic Stroke Management Guidelines Among Healthcare Providers in Jordanian Hospitals: A Cross‐Sectional Study
Ahmed Mohammed Al-Smadi, Heba Nabeel Nazih Al Salim, Salam Bani Hani, Ala Ashour, Omar Gammoh, Sireen Abdul Rahim Shilbayeh, Abedalmajeed Methqal ShajrawiBackground
A stroke is a neurological condition caused by the sudden and localized impairment of neurological function due to vascular causes, infarction, or hemorrhage. The management of ischemic stroke necessitates adherence to international guidelines to ensure the best practices. This study aims to explore the level of implementation of ischemic stroke management guidelines among physicians and nurses in Jordanian hospitals, as well as perceived barriers and suggested strategies for improvement.
Methods
A cross‐sectional descriptive research method was used. A self‐reporting questionnaire, designed based on the recent guidelines of AHA/ASA and ESO, and validated through an expert panel, was administered between the months of August and September 2023. The medical files of patients admitted for acute ischemic stroke from the period of March to July 2023 were reviewed retrospectively. Convenience sampling method was used to recruit 40 physicians and 120 nurses from three hospitals, whereas 150 participants were selected randomly for analysis.
Results
More than half of the physicians (57.2%) stated that they used first‐line intravenous thrombolysis properly. Results on acute stroke assessment and management pathways in the emergency department showed moderate compliance ( M = 1.38/3, SD = 0.49). In addition, mechanical thrombectomy procedures were not carried out for the reason that they were not available. Provision of healthy lifestyles showed higher results among physicians ( M = 2.52/4, SD = 0.55) than nurses. Results on nurses’ compliance with guideline‐recommended stroke management practices on post‐stroke patient care within the hospital ( M = 1.45/3, SD = 0.67) and healthy lifestyles ( M = 1.99/4, SD = 0.70) were moderate. Barriers that were identified included patients’ delayed presentation beyond the thrombolytic window and lack of sufficient insurance benefits. Respondents identified issues that needed governmental support and education to promote implementation. The analysis of the medical record showed some significant problems in the adherence to the stroke management protocols. First, the NIHSS score assessment was completed in 16.7% of the patients; the advanced vascular imaging (CTA/MRA) was performed in 16% of the patients; the thrombolysis was provided for 2.7% of the patients; and no mechanical thrombectomy procedures were carried out in the study group. Although most patients received proper discharge medications education, documentation of lifestyle counseling and secondary prevention advice was inadequate, suggesting inadequate stroke assessment, acute management, and patient education.
Conclusion
The present descriptive cross‐sectional study illustrates partial‐to‐moderate compliance with international guidelines for management of acute ischemic stroke in the participating Jordanian hospitals. It seems that higher compliance levels were found related to lifestyle changes and secondary prevention interventions than with certain processes of managing acute stroke patients, whereas no mechanical thrombectomy procedure was recorded in the analyzed medical records. The results of this study shed light on implementation patterns and barriers faced by participating hospitals and could potentially be used when developing quality improvement initiatives; however, it is not about cause‐and‐effect relations or testing an intervention’s effectiveness.