Allied Health Clinicians Using Translational Research in Action to Develop a Reliable Stroke Audit Tool

Objective: To design and establish reliability of a local stroke audit tool by engaging allied health clinicians within a privately funded hospital. Methods: Design: Two-stage study involving a modified Delphi process to inform stroke audit tool development and inter-tester reliability. Participants: Allied health clinicians. Interventions: A modified Delphi process to select stroke guideline recommendations for inclusion in the audit tool. Reliability study: 1 allied health representative from each discipline audited 10 clinical records with sequential admissions to acute and rehabilitation services. Main Outcome Measures: Recommendations were admitted to the audit tool when 70% agreement was reached, with 50% set as the reserve agreement. Inter-tester reliability was determined using intra-class correlation coefficients (ICCs) across 10 clinical records. Results: Twenty-two participants (92% female, 50% physiotherapists, 17% occupational therapists) completed the modified Delphi process. Across 6 voting rounds, 8 recommendations reached 70% agreement and 2 reached 50% agreement. Two recommendations (nutrition/hydration; goal setting) were added to ensure representation for all disciplines. Substantial consistency across raters was established for the audit tool applied in acute stroke (ICC .71; range .48 to .90) and rehabilitation (ICC.78; range .60 to .93) services. Conclusions: Allied health clinicians within a privately funded hospital generally agreed in an audit process to develop a reliable stroke audit tool. Allied health clinicians agreed on stroke guideline recommendations to inform a stroke audit tool. The stroke audit tool demonstrated substantial consistency supporting future use for service development. This process, which engages local clinicians, could be adopted by other facilities to design reliable audit tools to identify local service gaps to inform changes to clinical practice.