Effectiveness of Stroke Bundle Care in Emergency Unit on Acute Stroke Patient’s Outcome: Literature Review
Abstract
Background: Stroke leads to death and disability with continuously increasing incidence rates. Immediate management of acute stroke plays a crucial role in minimizing its impact. Comprehensive management through effective stroke bundle care in emergency units has been recognized as an efficient approach and is a crucial step in determining accurate actions, with the potential to enhance patient independence and reduce morbidity and mortality.
Objective: The aim of this theoretical study is to explore the impact of implementing a stroke care bundle in the emergency unit on the outcome of acute stroke patients.
Method: This study employs a literature review method with 20 journals from three databases: PubMed, Semantic Scholar, and Google Scholar.
Results: Stroke bundle care significantly improves patient outcomes, evident in increased Barthel Index and decreased mortality rates. Clinical factors, particularly NIHSS scores, significantly determine patient outcomes, and attention to nursing, time coordination, and clinical factor management can enhance stroke care effectiveness.
Conclusion: This study reaffirms that the implementation of stroke bundle care significantly enhances outcomes for patients with acute stroke by reducing mortality rates, improving independence, and fostering effective coordination among the care team.
Recommendation: Further integration of stroke bundle care into clinical practice is needed, with in-depth research on clinical factors and interdisciplinary collaboration to enhance acute stroke management.
References
Abedi A, Mirhaghi A, Ebrahimi M, Mazloum SR. Comparison between stroke triage scale and emergency severity Index to triage patients with neurological complaints: A randomized clinical trial. Int Emerg Nurs. 2020;53:100871. doi:10.1016/j.ienj.2020.100871.
Ai D, Gu Y, Xu S. Effectiveness of Multidisciplinary Nursing Based on Fever, Blood Sugar, and Swallowing Function Management in Patients with Acute Stroke. Evid Based Complement Alternat Med. 2022;2022:5949760. doi:10.1155/2022/5949760.
Berge E, et al. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J. 2021;6(1)–LXII. doi:10.1177/2396987321989865.
Chalos V, et al. National Institutes of Health Stroke Scale: An Alternative Primary Outcome Measure for Trials of Acute Treatment for Ischemic Stroke. Stroke. 2020;51(1):282–290. doi:10.1161/STROKEAHA.119.026791.
Chen L, Chen J, Zhang P. Application of Bundle Care in Patient with Individualized Sedation Care During the Interventional Therapy for Anterior-circulation Acute Ischemic Stroke. Am J Nurs Sci. 2020;9(2):79-83. doi:10.11648/j.ajns.20200902.18.
El-Aziz WW, Al-Metyazidy HA, Mansour HE, Weheida SM. The Effect of Implementing Initial Emergency Care Bundle on Early Outcomes among Acute Ischemic Stroke Patients. Egypt J Health Care. 2021;12(1):213-234. doi:10.21608/ejhc.2021.138795.
Feigin VL, Brainin M, Norrving B, Martins S, Sacco RL, Hacke W, Fisher M, Pandian J, Lindsay P. World Stroke Organization (WSO): Global Stroke Fact Sheet 2022. Int J Stroke. 2022 Jan;17(1):18-29. doi: 10.1177/17474930211065917.
Ghose SK, et al. Assessment of Initial Stroke Severity by National Institute Health Stroke Scale (NIHSS) Score at Admission. J Dhaka Med Coll. 2017;26(2):90-93. doi:10.3329/jdmc.v26i2.38765.
Grönberg A, Henriksson I, Lindgren A. Accuracy of NIH Stroke Scale for diagnosing aphasia. Acta Neurol Scand. 2021;143(4):375–382. doi:10.1111/ane.13388.
Huang L, et al. Effect of PDCA-based nursing intervention on activities of daily living, neurological function and self-management in acute cerebral stroke. Am J Transl Res. 2021;13(5):5315–5321.
Kementerian Kesehatan RI. Hasil Riset Kesehatan Dasar (Riskesdas) 2018. Jakarta: Badan Penelitian dan Pengembangan Kesehatan Kementerian RI; 2018. https://kesmas.kemkes.go.id/assets/upload/dir_519d41d8cd98f00/files/Hasil-riskesdas-2018_1274.pdf
Kummarg U, Sindhu S, Muengtaweepongsa S. The Early Outcomes of Nurse Case Management in Patients with Acute Ischemic Stroke Treated with Intravenous Recombinant Tissue Plasminogen Activator: A Prospective Randomized Controlled Trial. Neurol Res Int. 2018;2018:1717843. doi:10.1155/2018/1717843.
Middleton S, et al. Nurse-Initiated Acute Stroke Care in Emergency Departments: The Triage, Treatment, and Transfer Implementation Cluster Randomized Controlled Trial. Stroke. 2019;50(6):1346–1355. doi:10.1161/STROKEAHA.118.020701.
Mohamed RD, Hamad AH, Abouzied WR. Effect of initial stroke care bundle on clinical outcomes among patients with acute ischemic stroke. Egypt Nurs J. 2023;20(1):79-92. doi:10.4103/enj.enj_15_22.
Muhlis R. Hubungan Waktu Kedatangan Pasien Post Serangan Stroke Iskemik Akut ke Instalasi Gawat Darurat dengan Outcome Pasien Stroke Iskemik Akut. J Nurs Care Biomolecular. 2023;8(1):98-104.
Murphy SJ, Werring DJ. Stroke: causes and clinical features. Medicine (Abingdon). 2020 Sep;48(9):561-566. doi: 10.1016/j.mpmed.2020.06.002.
Nakibuuka J, et al. Effect of a 72 Hour Stroke Care Bundle on Early Outcomes after Acute Stroke: A Non Randomised Controlled Study. PLoS ONE. 2016;11(5):1-17. doi:10.1371/journal.pone.0154333.
Ouyang M, et al. Implementing a Goal-Directed Care Bundle after Acute Intracerebral Haemorrhage: Process Evaluation for the Third INTEnsive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial Study in China. Cerebrovasc Dis. 2022;51:373-383. doi:10.1159/000520669.
Rabinstein AA. Update on Treatment of Acute Ischemic Stroke. Continuum (Minneapolis, Minn.). 2020;26(2):268–286. doi:10.1212/CON.0000000000000840.
Ramachandran K, Radha D, Gaur A, Kaliappan A, Sakthivadivel V. Is the National Institute of Health Stroke Scale a valid prognosticator of the aftermath in patients with ischemic stroke? J Family Med Prim Care. 2022;11(11):7185–7190. doi:10.4103/jfmpc.jfmpc_611_22.
Regu M, Koul P. Effect of Comprehensive Nursing Care Strategies in Patient’s with Strke on Physiologic Parameters. Int J Nurs Midwifery Res. 2019;6(4):44-51. doi:10.24321/2455.9318.201932.
Reznik ME, et al. Baseline NIH Stroke Scale is an inferior predictor of functional outcome in the era of acute stroke intervention. Int J Stroke. 2018;13(8):806–810. doi:10.1177/1747493018783759.
Sykora M, et al. Intravenous thrombolysis in stroke with admission NIHSS score 0 or 1. Int J Stroke. 2022;17(1):109–119. doi:10.1177/1747493021991969.
Turner M, et al. Implementing a simple care bundle is associated with improved outcomes in a national cohort of patients with ischemic stroke. Stroke. 2015;46(4):1065–1070. doi:10.1161/STROKEAHA.114.007608.
Authors who publish with Journal of Public Health and Pharmacy retain the copyright of their work. The journal applies a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0), which grants the following rights:
-
Copyright Retention: Authors retain the copyright of their work, maintaining full control over their intellectual property without restrictions.
-
Right of First Publication: Authors grant the journal the right of first publication of their work. This ensures that the work is initially published and credited in Journal of Public Health and Pharmacy.
-
License to Share and Reuse: The work is licensed under CC BY-SA 4.0, allowing others to copy, distribute, remix, and build upon the work for any purpose, even commercially, as long as proper credit is given to the authors, and any new creations are licensed under the same terms.
