Research leads to dramatically improved stroke patient outcomes

Wednesday, 12 October 2011

Study: Implementation of three clinical protocols dramatically improves stroke patient outcomes

Acute stroke patients who receive three clinical protocols to manage fever, sugar and swallowing are 16 per cent more likely to be alive and independent three months later - a collaborative research study led by Professor Sandy Middleton, Director of the Nursing Research Institute at Australian Catholic University and St Vincents & Mater Health Sydney has found. 

The landmark research took out top honours at the 2011 Canadian Stroke Congress, and received widespread media coverage after it was published in The Lancet medical journal in October.

Professor Middleton has since been awarded an additional $2.25 million in funding from the National Health and Medical Research Council (NHMRC) to roll out the trial in emergency departments around Australia.

Stroke is caused by a clot or a bleed in the brain and is Australia’s second biggest cause of death and leading cause of disability. While a patient suffers irreversible brain damage as a result of the stroke, there is potential to salvage surrounding brain tissue and limit the damage by effectively managing fever, sugar and swallowing.

The NHMRC-funded trial is the first nurse-led trial in acute stroke of its kind carried out in Australia and involved 19 acute stroke units across New South Wales and more than 1,600 patients.

The trial developed, implemented and evaluated the effectiveness of team-building workshops and education to introduce three clinical protocols to manage fever, sugar and swallowing (the FeSS protocols) following an acute stroke.

“Patients admitted with an acute stroke to hospitals that were randomised to receive our support to implement these FeSS protocols, were 16 per cent more likely to be alive and independent at 90 days.” Professor Middleton said.

“These results are better than any current drug or treatment for stroke including clot-busting therapy, and can be universally applied in acute stroke units.”

Published online in The Lancet today, the study showed that patients who received care in stroke units using these protocols were also more likely to have fewer episodes of fever, lower average temperatures and sugar levels, and better screening for swallowing difficulties.

“We found better outcomes for patients and consistently better processes of care in these hospitals because we created opportunities for teams to come together and agree on what they could do as an integrated service to improve quality of care. These results provide some of the best evidence to date in Australia on how to change clinicians’ behaviour and also evidence for effective team work and good nursing care,” Professor Middleton said.

“Good management of fever, high blood sugar levels and swallowing can salvage brain tissue - poor management however can result in extension of the stroke and have devastating consequences for the patient.”

The study was a collaboration between Australian Catholic University, the University of Newcastle, the University of Ottawa, the University of Western Sydney, the University of Sydney and the University of Melbourne, as well as a team of clinicians from NSW Health and support from the Agency for Clinical Innovation’s Stroke Services NSW.

The National Stroke Foundation is encouraging the delivery of such programs in Australian stroke units to support the use of the FeSS protocols based on the success of Professor Middleton’s trial.

“Recovery after a stroke can be significantly improved when health professionals are supported to implement protocols that ensure consistent and prompt clinical management of these three factors – fever, blood sugar levels and swallowing. Stroke is Australia’s second leading cause of death and a major cause of disability. The delivery of programs resulting in improved care for stroke care is critical in ensuring more Australians survive stroke, and that costs associated with stroke care are minimised,” said CEO Dr Erin Lalor.

Professor Middleton said she had been delighted to find so many stroke units eager to step up and adopt best practice:  “This is great news for evidence-based health care.”

For more information on the study visit