Evidence map›Paper›PMID 31699711›Full record

Observational studyBMJ open2019

What does it take to provide clinical interventions with temporal consistency? A qualitative study of London hyperacute stroke units.

Georgia B Black, Angus I G Ramsay, Abigail Baim-Lance, Jeannie Eng, Mariya Melnychuk, Penny Xanthopoulou, Martin M Brown, Stephen Morris, Anthony G Rudd, Robert Simister and 1 more

Open access · goldAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
0.8field-weighted citation impact, top 25% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 7 citations in OpenAlex.

  1. Article
  2. A scoping review of patient and public involvement in empirical stroke research.International journal of stroke : official journal of the International Stroke Society · 2024
    Article
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 7 institutions in 2 countries.

Georgia B Black *Department of Applied Health Research, University College London, London, UK.ORCID 0000-0003-2676-5071
Angus I G Ramsay *Department of Applied Health Research, University College London, London, UK.
Abigail Baim-LanceCity University of New York System, New York City, New York, USA.
Jeannie EngBarts Health NHS Trust, London, UK.
Mariya MelnychukDepartment of Applied Health Research, Imperial College London, London, UK.
Penny XanthopoulouDepartment of Psychology, University of Exeter, Exeter, UK.ORCID 0000-0002-1510-3382
Martin M BrownDepartment of Neurology, University College London, London, UK.
Stephen MorrisDepartment of Applied Health Research, University College London, London, UK.
Anthony G RuddClinical Effectiveness and Evaluation Unit, Royal College of Physicians, London, UK.
Robert SimisterComprehensive Stroke Service, University College London Hospitals NHS Foundation Trust, London, UK.
Naomi J FulopDepartment of Applied Health Research, University College London, London, UK.ORCID 0000-0001-5306-6140
University College London · GBBarts Health NHS Trust · GBCity University of New York · USImperial College London · GBRoyal College of Physicians · GBUniversity College London Hospitals NHS Foundation Trust · GBUniversity of Exeter · GB

Funding

Department of Health 12/128/41
6 · The paper itself

Abstract

objectivesSeven-day working in hospitals is a current priority of international health research and policy. Previous research has shown variability in delivering evidence-based clinical interventions across different times of day and week. We aimed to identify factors influencing such variations in London hyperacute stroke units (HASUs).

designInterview and observation study to explain patterns of variation in delivery and outcomes of care described in a quantitative partner paper (Melnychuk

settingEight HASUs in London.

participantsWe interviewed HASU staff (n=76), including doctors, nurses, therapists and administrators. We also conducted non-participant observations of delivery of care at different times of the day and week (n=45; ~102 hours). We analysed the data for thematic content relating to the ability of staff to provide evidence-based interventions consistently at different times of the day and week.

resultsStaff were able to deliver 'front door' interventions consistently by taking on additional responsibilities out of hours (eg, deciding eligibility for thrombolysis); creating continuities between day and night (through, eg, governance processes and staggering rotas); building trusting relationships with, eg, Radiology and Emergency Departments and staff prioritisation of 'front door' interventions. Variations by time of day resulted from reduced staffing in HASUs and elsewhere in hospitals in the evenings and at the weekend. Variations by day of week (eg, weekend effect) resulted from lack of therapy input and difficulties repatriating patients at weekends, and associated increases in pressure on Fridays and Mondays.

conclusionsEvidence-based service standards can facilitate 7-day working in acute stroke services. Standards should ensure that the capacity and capabilities required for 'front door' interventions are available 24/7, while other services, for example, therapies are available every day of the week. The impact of standards is influenced by interdependencies between HASUs, other hospital services and social services.

Indexed as

Qualitative ResearchDelivery of Health CareEmergency Service, HospitalHumansIncidenceLondonStrokehealth policyorganisation of health servicesqualitative researchstrokestroke medicine

Identifiers

PMID31699711
PMCPMC6858131
OpenAlexW2986115022

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.