Affiliations 

  • 1 The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  • 2 Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
  • 3 The Department of Neurosciences Nursing, The Johns Hopkins Hospital, Baltimore, Maryland, USA
  • 4 Physical Medicine and Rehabilitation Department, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  • 5 Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  • 6 Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri, USA
  • 7 Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
  • 8 Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
  • 9 NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
  • 10 Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
  • 11 Department of Neurology, Shenyang First People's Hospital, Shenyang Medical College Affiliated Brain Hospital, Shenyang Brain Institute, Shenyang, China
  • 12 Medical Department, Hospital Canselor Tuanku Muhriz, Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
  • 13 The George Institute for Global Health, Sydney, New South Wales, Australia
Cerebrovasc Dis, 2025;54(1):96-104.
PMID: 38442704 DOI: 10.1159/000538136

Abstract

INTRODUCTION: The ongoing OPTIMISTmain study, an international, multicenter, stepped-wedge cluster randomized trial, aims to determine effectiveness and safety of low-intensity versus standard monitoring in thrombolysis-treated patients with mild-to-moderate acute ischemic stroke (AIS). An embedded process evaluation explored integration and impact of the intervention on care processes at participating US sites.

METHODS: A mixed-methods approach with quantitative and qualitative data was collected between September 2021 and November 2022. Implementer surveys were undertaken at pre- and post-intervention phases to understand the perceptions of low-intensity monitoring strategy. A sample of stroke care nurses were invited to participate in semi-structured interviews at an early stage of post-intervention. Qualitative data were analyzed deductively using the normalization process theory; quantitative data were tabulated.

RESULTS: Interviews with 21 nurses at 8 hospitals have shown low-intensity monitoring was well accepted as there were less time constraints and reduced workload for each patient. There were initial safety concerns over missing deteriorating patients and difficulties in changing established routines. Proper training, education, and communication, and changing the habits and culture of care, were key elements to successfully adopting the new monitoring care into routine practice. Similar results were found in the post-intervention survey (42 nurses from 13 hospitals). Nurses reported time being freed up to provide patient education (56%), daily living care (50%), early mobilization (26%), mood/cognition assessment (44%), and other aspects (i.e., communication, family support).

CONCLUSIONS: Low-intensity monitoring for patients with mild-to-moderate AIS, facilitated by appropriate education and organizational support, appears feasible and acceptable at US hospitals.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.