In-hospital onset strokes represent 4% to 20% of all reported strokes in the United States. The variability of treatment protocols and workflows as well as the complex etiology and multiple comorbidities of the in-hospital stroke subpopulation often result in unfavorable outcomes and higher mortality rates compared to those who experience strokes outside of the hospital setting. The purpose of this project was to conduct a systematic review to identify and summarize effective strategies and practices for prompt recognition and treatment of in-hospital strokes. The results of the literature review with leading-edge guidelines for stroke care were corelated to formulate recommendations at an organizational level for improving care delivery and workflow. Peer-reviewed publications and literature not controlled by publishers were analyzed. An appraisal of 24 articles was conducted, using the guide for classification of level of evidence by Fineout-Overholt, Melnyk, Stillwell, and Williamson. The results of this systematic review revealed that the most effective strategies and practices for prompt recognition and treatment of in-hospital strokes included: staff education, creating a dedicated responder team, analysis and improvement of internal processes to shorten the time from discovery to diagnosis, and offering appropriate evidence-based treatments according to acute stroke guidelines. Creating organizational protocols and quality metrics to promote timely and evidence-based care for in-hospital strokes may result in a positive social change by eliminating the existing care disparities between community and in-hospital strokes and improving the health outcomes of this subpopulation of strokes.

Dagens komplexa vårdmiljö kan förenklas genom att utrusta sjukhusensoperationssalar med en integrerad systemlösning. Syftet är att möjliggöramanövrering av all utrustning från en gemensam enhet, och på så sätt effektiviseraarbetsflödet. Idag saknas data som stödjer påståendet att systemetsförprogrammerade scenarion innebär en förbättring. Det här arbetet går ut på att undersöka den nytta som integrationslösningenmedför i operationssalar. Detta görs genom att undersöka arbetsflödet utifrån treolika styrningsfall (med förprogrammerade scenarion, manuellt via applikationeroch exludering av systemet), samt utifrån tre olika mätparametrar (klick, steg ochtid). Syftet med jämförelsen är att se vilket av dessa fall som är optimalt utifrån ettanvändarperspektiv. Resultatet visar på en tydlig fördel för styrning av systemet med förprogrammeradescenarion utifrån samtliga mätparametrar. De antaganden som har formatundersökningen, samt de kvantitativa begränsningarna i studiens data, tas hänsyntill i analysen. Under analys stärks det framtagna resultatet. I kombination med en fördeladstyrning mellan användarna utgör styrning med förprogrammerade scenarion detbästa alternativet för ett optimerat arbetsflöde. / Healthcare system complexity can be simplified by equipping hospital operatingtheatres with an integrated system solution. The goal is to improve the hospitalworkflow by enabling maneuvering of all the equipment from a common unit.Today there is no data to support the claim that the system offered feature of usingpreset scenes provides any improvements. The aim of this study is to demonstrate the benefits of the integrated operatingsystem. This is done by performing a workflow analysis based on three differentcases (with preset scenes, maneuvered through the applications and without use ofthe integrated system) and three different parameters (clicks, steps, and time). Thepurpose is to clarify the, from a user perspective, most beneficial case. The measured result shows an advantage when using the system with presetscenes. All of the assumptions in the survey, including the limitations ofquantitative data, are considered in the study. The result is validated by the analysis. A combination of the case with preset scenesand a distributed control between the users are therefore the best alternative for anoptimized workflow.