Measuring organizational context in Australian emergency departments and its impact on stroke care and patient outcomes.

BACKGROUND:Emergency departments (ED) are challenging environments but critical for early management of patients with stroke. PURPOSE:To identify how context affects the provision of stroke care in 26 Australian EDs. METHOD:Nurses perceptions of ED context was assessed with the Alberta Context Tool. Medical records were audited for quality of stroke care and patient outcomes. FINDINGS:Collectively, emergency nurses (n = 558) rated context positively with several nurse and hospital characteristics impacting these ratings. Despite these positive ratings, regression analysis showed no significant differences in the quality of stroke care (n = 1591 patients) and death or dependency (n = 1165 patients) for patients in EDs with high or low rated context. DISCUSSION:Future assessments of ED context may need to examine contextual factors beyond the scope of the Alberta Context Tool which may play an important role for the understanding of stroke care and patient outcomes in EDs.