From QASC to QASCIP: successful Australian translational scale-up and spread of a proven intervention in acute stroke using a prospective pretest/ post-test study design

Journal article


Middleton, Sandy, Lydtin, Anna, Comerford, Daniel, Cadilhac, Dominique, McElduff, Patrick, Dale, Simeon, Hill, Kelvin, Longworth, Mark, Ward, Jeanette, Cheung, N. and D'Este, Cate. (2016) From QASC to QASCIP: successful Australian translational scale-up and spread of a proven intervention in acute stroke using a prospective pretest/ post-test study design. BMJ Open. 6(5), pp. 1 - 14. https://doi.org/10.1136/bmjopen-2016-011568
AuthorsMiddleton, Sandy, Lydtin, Anna, Comerford, Daniel, Cadilhac, Dominique, McElduff, Patrick, Dale, Simeon, Hill, Kelvin, Longworth, Mark, Ward, Jeanette, Cheung, N. and D'Este, Cate
Abstract

Objectives To embed an evidence-based intervention to manage FEver, hyperglycaemia (Sugar) and Swallowing (the FeSS protocols) in stroke, previously demonstrated in the Quality in Acute Stroke Care (QASC) trial to decrease 90-day death and dependency, into all stroke services in New South Wales (NSW), Australia's most populous state. Design Pre-test/post-test prospective study. Setting 36 NSW stroke services. Methods Our clinical translational initiative, the QASC Implementation Project (QASCIP), targeted stroke services to embed 3 nurse-led clinical protocols (the FeSS protocols) into routine practice. Clinical champions attended a 1-day multidisciplinary training workshop and received standardised educational resources and ongoing support. Using the National Stroke Foundation audit collection tool and processes, patient data from retrospective medical record self-reported audits for 40 consecutive patients with stroke per site pre-QASCIP (1 July 2012 to 31 December 2012) were compared with prospective self-reported data from 40 consecutive patients with stroke per site post-QASCIP (1 November 2013 to 28 February 2014). Inter-rater reliability was substantial for 10 of 12 variables. Primary outcome measures Proportion of patients receiving care according to the FeSS protocols pre-QASCIP to post-QASCIP. Results All 36 (100%) NSW stroke services participated, nominating 100 site champions who attended our educational workshops. The time from start of intervention to completion of post-QASCIP data collection was 8 months. All (n=36, 100%) sites provided medical record audit data for 2144 patients (n=1062 pre-QASCIP; n=1082 post-QASCIP). Pre-QASCIP to post-QASCIP, proportions of patients receiving the 3 targeted clinical behaviours increased significantly: management of fever (pre: 69%; post: 78%; p=0.003), hyperglycaemia (pre: 23%; post: 34%; p=0.0085) and swallowing (pre: 42%; post: 51%; p=0.033). Conclusions We obtained unprecedented statewide scale-up and spread to all NSW stroke services of a nurse-led intervention previously proven to improve long-term patient outcomes. As clinical leaders search for strategies to improve quality of care, our initiative is replicable and feasible in other acute care settings.

Year2016
JournalBMJ Open
Journal citation6 (5), pp. 1 - 14
PublisherThe BMJ Publishing Group
ISSN2044-6055
Digital Object Identifier (DOI)https://doi.org/10.1136/bmjopen-2016-011568
Scopus EID2-s2.0-84971320499
Open accessOpen access
Page range1 - 14
Research GroupNursing Research Institute
Publisher's version
Place of publicationUnited Kingdom
EditorsT. Groves
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