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Fever, Hyperglycemia, and Swallowing Management in Stroke Unit and Non–Stroke-Unit European Hospitals : A Quality in Acute Stroke Care (QASC) Europe Substudy
Ding, Ranran Betihavas, Vasiliki McElduff, Benjamin Dale, Simeon Coughlan, Kelly McInnes, Elizabeth Catherine Middleton, Sandra Jane Fasugba, Oyebola
Ding, Ranran
Betihavas, Vasiliki
McElduff, Benjamin
Dale, Simeon
Coughlan, Kelly
McInnes, Elizabeth Catherine
Middleton, Sandra Jane
Fasugba, Oyebola
Abstract
Stroke unit care reduces patient morbidity and mortality. The Quality in Acute Stroke Care Europe Study achieved significant large-scale translation of nurse-initiated protocols to manage Fever, hyperglycemia (Sugar), and Swallowing (FeSS) in 64 hospitals across 17 European countries. However, not all hospitals had stroke units. Our study aimed to compare FeSS protocol adherence in stroke unit versus non–stroke-unit hospitals. METHODS: An observational study using Quality in Acute Stroke Care Europe Study postimplementation data was undertaken. Hospitals were categorized using 4 evidence-based characteristics for defining a stroke unit, collected from an organizational survey of participating hospitals. Differences in FeSS Protocol adherence between stroke unit and non–stroke-unit hospitals were investigated using mixed-effects logistic regression, adjusting for age, sex, and National Institutes of Health Stroke Scale. RESULTS: Of the 56 hospitals from 16 countries providing organizational data, 34 (61%) met all 4 stroke unit characteristics, contributing data for 1825 of 2871 patients (64%) (stroke unit hospitals). Of the remaining 22 hospitals (39%), 17 (77%) met 3 of the 4 stroke unit characteristics (non–stroke-unit hospitals). There were no differences between hospitals with a stroke unit and those without for postimplementation adherence to fever (49% stroke unit vs 57% non–stroke unit; odds ratio [OR], 0.400; 95% confidence interval [CI], 0.087-1.844; P = .240), hyperglycemia (50% stroke unit vs 57% non–stroke unit; OR, 0.403; 95% CI, 0.087–1.856; P = .243), swallowing (75% stroke unit vs 60% non–stroke unit; OR, 1.702; 95% CI, 0.643–4.502; P = .284), or overall FeSS Protocol adherence (36% stroke unit vs 36% non–stroke unit; OR, 0.466; 95% CI, 0.106–2.043; P = .311). CONCLUSION: Our results demonstrate that the nurse-initiated FeSS Protocols can be implemented by hospitals regardless of stroke unit status. This is noteworthy because hospitals without stroke unit resources that care for acute stroke patients can potentially implement these protocols. Further effort is needed to ensure better adherence to the FeSS Protocols.
Keywords
dysphagia, FeSS, fever, hyperglycemia, implementation, QASC, stroke, stroke unit, swallow
Date
2024
Type
Journal article
Journal
Book
Volume
56
Issue
2
Page Range
42-48
Article Number
ACU Department
School of Nursing, Midwifery and Paramedicine
Faculty of Health Sciences
Nursing Research Institute
Faculty of Health Sciences
Nursing Research Institute
Relation URI
Event URL
Open Access Status
License
File Access
Controlled
Notes
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