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Implementation of Low-Intensity Thrombolysis Monitoring Care in Routine Practice: Process Evaluation of the Optimal Post rtPA-IV Monitoring in Acute Ischemic Stroke Study in the USA

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dc.contributor.authorOuyang, Menglu
dc.contributor.authorGonzález, Francisca
dc.contributor.authorMontalbano, Michelle
dc.contributor.authorPruski, April
dc.contributor.authorJan, Stephen
dc.contributor.authorWang, Xia
dc.contributor.authorJohnson, Brenda
dc.contributor.authorSummers, Debbie
dc.contributor.authorKhatri, Pooja
dc.contributor.authorMalavera, Alejandra
dc.contributor.authorFaigleg, Roland
dc.contributor.authorMunoz Venturelli, Paula
dc.contributor.authorUrrutia, Francisca
dc.contributor.authorDay, Diana
dc.contributor.authorRobinson, Thompson
dc.contributor.authorDurham, Alice
dc.contributor.authorEbraimo, Ahtasam
dc.contributor.authorSong, Lili
dc.contributor.authorSu, Yi
dc.contributor.authorZaidi, Wan Asyraf Wan
dc.contributor.authorLindley, Richard
dc.contributor.authorDelcour, Candice
dc.contributor.authorCruz, Victor
dc.contributor.authorAnderson, Craig
dc.contributor.authorLiu, Hueiming
dc.date.accessioned2026-08-10T18:03:23Z
dc.date.available2026-08-10T18:03:23Z
dc.date.issued2025
dc.description.abstractIntroduction: 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.
dc.description.versionVersión Publicada
dc.identifier.citationOuyang M, González F, Montalbano M, Pruski A, Jan S, Wang X, Johnson B, Summers DV, Khatri P, Malavera A, Iacobelli M, Faigle R, Munoz-Venturelli P, Urrutia Goldsack F, Day D, Robinson TG, Durham AC, Ebraimo A, Song L, Sui Y, Wan Zaidi WA, Lindley RI, Delcourt C, Urrutia VC, Anderson CS, Liu H. Implementation of Low-Intensity Thrombolysis Monitoring Care in Routine Practice: Process Evaluation of the Optimal Post rtPA-IV Monitoring in Acute Ischemic Stroke Study in the USA. Cerebrovasc Dis. 2025;54(1):96-104. doi: 10.1159/000538136
dc.identifier.doihttps://doi.org/10.1159/000538136
dc.identifier.urihttps://hdl.handle.net/11447/10985
dc.language.isoen
dc.subjectImplementation
dc.subjectIschemic stroke
dc.subjectLow-intensity monitoring
dc.subjectProcess evaluation
dc.subjectThrombolysis
dc.titleImplementation of Low-Intensity Thrombolysis Monitoring Care in Routine Practice: Process Evaluation of the Optimal Post rtPA-IV Monitoring in Acute Ischemic Stroke Study in the USA
dc.typeArticle
dcterms.sourceCerebrovascular diseases
dspace.entity.typePublication
relation.isAuthorOfPublication77bec604-0a16-4d85-aaee-734c326e253a
relation.isAuthorOfPublication.latestForDiscovery77bec604-0a16-4d85-aaee-734c326e253a

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