The Development of stroke patient referral model Khamcha-i Hospital, Mukdahan Province.

Abstract

This study utilized an action research design guided by the framework of Kemmis and McTaggart, which comprises four iterative phases: (1) Planning, (2) Action, (3) Observation, and (4) Reflection. The objectives of the study were to: (1) examine existing problems and compare stroke patient care outcomes before and after the implementation of a care and referral model; (2) evaluate the knowledge and skills of registered nurses in caring for and referring stroke patients at Kamcha-i Hospital, Mukdahan Province; and assess the satisfaction levels of patients’ family members regarding stroke care and referral services. The sample consisted of 32 registered nurses and 40 stroke patients, with 20 patients in the pre-intervention phase and 20 in the post-intervention phase. Research instruments included: a data collection form for stroke patient care retrieved from medical records, a knowledge and skills assessment tool for nurses involved in stroke care and referral, and a satisfaction survey for patients' relatives regarding the quality of stroke care and referral services. Data analysis was conducted using descriptive statistics, content analysis, and independent t-tests to compare outcomes before and after implementation.

The results were shown 1) developed stroke referral model consisted of screening stroke patients to assess urgency and providing pre-referral care based on urgency level. After implementation, the number of patients referred through the Stroke Fast Track system increased significantly (p < .05), and the average time spent on pre-referral care decreased significantly from 42.45 minutes to 27.75 minutes—a reduction of 14.75 minutes (p < .05)., 2) the nurses’ average knowledge and skills score in stroke care and referral was 82.87%, indicating an excellent level, and 3) The satisfaction level of patients’ relatives regarding stroke care and referral was rated as very high. It is recommended that all nursing departments and relevant healthcare organizations conduct annual training and refresher sessions on stroke care and referral protocols. Additionally, the effectiveness of the referral model should be reviewed and evaluated every three months to ensure continued quality improvement and patient safety.