Abstract NS23: Changing State-wide Stroke Practice: The QASC Implementation Project
Background: The Quality in Acute Stroke Care (QASC) Trial1 determined that a multidisciplinary supported, nurse-initiated, evidence-based intervention involving supported implementation of clinical protocols to manage fever, hyperglycaemia and swallowing (FeSS protocols) following stroke decreased death and dependency by 16% (p=0.002); reduced temperatures (p=0.001) and glucose levels (p=0.02); and improved swallowing management (p=<0.001). Yet, upscale and spread of even proven interventions on a state-wide level is challenging.
Aim: To implement the FeSS protocols from the QASC Trial in all 36 stroke services in NSW, Australia.
Method: Our 14 month translational project replicated the intervention from the original QASC Trial. We conducted barrier and enabler assessments and an educational workshop, engaged local opinion leaders, used reminders, and provided ongoing site champion support. Participating sites audited 40 pre-, and 40 post- implementation medical records using the National Stroke Foundation clinical audit web-based tool.
Results: All (n=36, 100%) sites participated in the medical record audit (100% response rate) providing data for a total of 2144 patients (pre-implementation: n= 1062; post-implementation: n=1082). Significantly increased proportions of patients received care according to the fever (pre: 69%; post: 78%; p=0.0031), hyperglycaemia (pre: 23%; post: 34%; p=0.0085), and swallowing (pre: 42%; post: 51%; p=0.0331) protocols post-implementation.
Conclusion: Our results provide rare evidence of successful research translation of Class 1 Level B evidence across an entire state in a short time-frame and in the real world of clinical practice.
Author Disclosures: S. Middleton: None. D. Comerford: None. A. Lydtin: None. S. Dale: None. D. Cadilhac: None. C. D'Este: None. P. McElduff: None. K. Hill: None. N. Cheung: None. C. Levi: None. M. Longworth: None. J. Ward: None. C. Quinn: None.
- © 2015 by American Heart Association, Inc.