Interdisciplinary interactions, social systems and technical infrastructure required for successful implementation of mobile stroke units: A qualitative process evaluation.

2023-04

Bagot, Kathleen L

Purvis, Tara

Hancock, Shaun

Zhao, Henry

Coote, Skye

Easton, Damien

Campbell, Bruce C V

Davis, Steve M

Donnan, Geoff A

Foster, Shane

Langenberg, Francesca

Smith, Karen

Stephenson, Michael

Bernard, Stephen

McGowan, Sharon

Yan, Bernard

Mitchell, Peter

Middleton, Sandy

Cadilhac, Dominique A

ambulances

health services research

hospitals

implementation science

mixed methods research

mobile stroke unit

process evaluation

qualitative research

stroke

Journal Article

0000-0003-2895-4327

0000-0003-3332-5357

0000-0002-2015-2752

0000-0002-4320-4287

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0000-0002-1773-5332

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0000-0002-7201-4394

0000-0001-8162-682X

10.1111/jep.13803

Mobile stroke units (MSUs) are increasingly being implemented to provide acute stroke care in the prehospital environment, but a comprehensive implementation evaluation has not been undertaken. To identify successes and challenges in the pre- and initial operations of the first Australian MSU service from an interdisciplinary perspective. Process evaluation of the Melbourne MSU with a mixed-methods design. Purposive sampling targeted key stakeholder groups. Online surveys (administered June-September 2019) and semistructured interviews (October-November 2019) explored experiences. Directed content analysis (raters' agreement 85%) and thematic analysis results are presented using the Interactive Sociotechnical Analysis framework. Participants representing executive/program operations, MSU clinicians and hospital-based clinicians completed 135 surveys and 38 interviews. Results converged, with major themes addressing successes and challenges: stakeholders, vehicle, knowledge, training/education, communication, work processes and working relationships. Successes and challenges of establishing a new MSU service extend beyond technical, to include operational and social aspects across prehospital and hospital environments.

link

Journal of Evaluation in Clinical Practice 2023; 29(3)

Journal of Evaluation in Clinical Practice

1365-2753