A novel international collaboration with the European Stroke Organisation; the European Acute Networks Striving for Excellence in Stroke (Angels) Initiative (a not-for-profit industry initiative dedicated to advancing stroke care); the European Registry of Stroke Care Quality (RES-Q); and our research team facilitated the rollout of the fever, hyperglycaemia (sugar) and swallow (FeSS) Protocols into European stroke services across 64 hospitals, in 17 countries..

Proven implementation science strategies used in earlier research (QASC, QASCIP) were adapted to support FeSS Protocol introduction into real-time, real world clinical practice. Project resources were translated into 13 different languages.

Our pre-test/ post-test study involving 7256 patients, demonstrated a significant improvement (over 30%) in nurse-initiated management of FeSS in European stroke units with vastly different health care systems. At the study conclusion, participating hospitals were encouraged to take their final post-implementation report with implications and recommendations as evidence to their local policy and decision makers to demonstrate the impact of the nurse-initiated FeSS Protocols

The project also boosted efforts to build country stroke nursing networks and share outputs with counterparts in other hospitals, some for the first time. Beyond the life of this project we have also seen the inclusion of the FeSS Protocols in some national guidelines:

2019: Inclusion of FeSS Protocols in Romanian National Clinical Guidelines for Stroke 

2021: Inclusion of FeSS Protocols in Lazio region (Italy) Clinical Guidelines for Stroke

2021: Inclusion of FeSS Protocols in Kazakhstan National Clinical Guidelines for Stroke (under consideration)

The impact of providing stroke nurses with the support, knowledge and resources to be leaders in best clinical practice, has the potential to improve patient outcomes and advance the science of stroke nursing care globally. This model could also be applied to other clinical areas

If you would like to get in contact with us, please email QASC@acu.edu.au

Media resources

QASC Europe video

Middleton S, Pfeilschifter W. International translation of Fever, Sugar, Swallow Protocols: The Quality in Acute Stroke Care Europe Project. Int J Stroke. 2020 Aug;15(6):591-594. doi: 10.1177/1747493020915130. Epub 2020 Apr 16. PMID: 32299312.

McInnes, E., Dale, S., Bagot, K. et al.The Quality in Acute Stroke Care (QASC) global scale-up using a cascading facilitation framework: a qualitative process evaluation. BMC Health Serv Res 24, 144 (2024). https://doi.org/10.1186/s12913-024-10617-9

Ding R, Betihavas V, McElduff B, Dale S, Coughlan K, McInnes E, et al. Fever, Hyperglycemia, and Swallowing Management in Stroke Unit and Non–Stroke-Unit European Hospitals: A Quality in Acute Stroke Care (QASC) Europe Substudy. Journal of Neuroscience Nursing. 2023. http://DOI.org/10.1097/JNN.0000000000000743  

Professor Waltraud Pfeilschifter (Chair, Goethe University Frankfurt, Germany)
Professor Dominique Cadilhac (Monash University, Australia)
Dr Luca Casertano (Manager of the Hospital Network Planning, Lazio region, Italy)
Professor Anne-Kathrin Cassier-Woidasky (University of Applied Sciences Saarland, Germany)
Professor N Wah Cheung (Sydney University, Australia)
Dr Igor Crivorucica (Institute of Emergency Medicine, Moldova)
Ms Simeon Dale (Australian Catholic University, Australia)
Professor Cate D’Este (Sax Institute, Sydney; Australian National University, Australia)
Dr Oganes Ezoyen (Erebouni Medical Centre, Armenia)
Dr. Joerg Glahn (Department of Neurology Johannes Wesling Klinikum, Germany)
Ms Andreea Grecu (RES-Q, St. Anne’s University Hospital, Brno, Czech Republic)
Professor Jeremy M. Grimshaw (Ottawa University, Canada)
Ms Olga Jarmak (Kharkiv Railway Clinical Hospital, Ukraine)
Professor Chris Levi (University of New South Wales, Australia)
Ms Tereza Loucna (Faculty Hospital Motol, Prague, Czech Republic)
Professor Elizabeth McInnes (Australian Catholic University, Australia)
Ms Sabina Medukhanova (National Center for Neurosurgery, Kazakhstan)
Mr Gert Messchendorp (University Medical Center Groningen, Netherlands)
Professor Sandy Middleton (Australian Catholic University, Australia)
Ms Clare Quinn (Prince of Wales Hospital, Australia)
Ms Marieke Rijksen (SPM Consult, Netherlands)
Ms Mercè Salvat Plana (Catalan Stroke Programme, Spain)
Ms Susana Salselas (Stroke Unit, UH Macedo Cavaleiros, Portugal)
Dr Estela Sanjuan Menendez (Vall d'Hebron University Hospital, Spain)
Dr Marcelina Skrzypek-Czerko (Medical University of Gdańsk, Poland)
Ms Antonella Urso (Hospital Network Area-Regional Health Department, Regione Lazio, Italy)

QASC Europe collaborators

Armenia

Country Coordinator: O Ezoyan

Erebouni Medical Centre : O Ezoyan, N Yeghiazaryan

Yerevan State Medical University Hospital : Y Hovhannisyan, L Khachatryan

 

Belarus

Country Coordinator: S Marchenko

Minsk City Emergency Hospital : S Marchenko, I Hil

Bulgaria

University First Multifunctional Hospital for Active treatment (MBAL) - Sofia "St Ioan Krastitel " :

D Maslarov, D Drenska, V Georgieva, K Yordanova, V Milenkova

Multifunctional Hospital for Active treatment (MBAL) Sveti Panteleimon : D Kasabova,

P Kacarova, M Hristova

Czech Republic

Country Coordinator: T Loucna

Nemocnice Vyškov, p.o. : J Kadlčíková, E Fryčová, L Hanousková

Masarykova nemocnice v Ústí nad Labem o.z. - Krajská zdravotní a.s. : S Brušáková, D Černík

Hospital Chomutov : J Pospíchalová; J Neumann, P Pöschlová, J Macko 

Hospital Sokolov : A Novák, K Tvrdá, V Šarišská

Faculty hospital Olomouc : K Plachetková

Faculty Hospital Motol : A Tomek, T Loucna

Karvinská hornická nemocnice : A Bilanová

Hospital Nachod: P Štěpán

Hospital Decin

France

Clinique Mutualiste de Lyon:

The Pierre Wertheimer Hospital: N Nighoghossian

CHU Grenoble Alpes: O Detante

Georgia

Country Coordinator: N Lobjanidze

First University Hospital of Tbilisi State Medical University : M Kekenadze

West Georgia Medical Center, Kutaisi: T Janelidze, G Giorgidze

Medcenter Batumi Hospital: J Makaradze, L Qamadadze; N Pilia; E Zanaqidze; M Dolidze

Pineo Medical Ecosystem : A Tsiskaridze, N Lobjanidze, N Guldedava

Italy

Country Coordinator: A Urso

SS Filippo and Nicola Hospital : G Di Vito, F Scatena, M Conti, E Salvi, M D’Agostino

Hospital Villa Sofia, Palermo : V Terruso, A Gasparro, R Lucido, V Giuffrida, O Mirotta,

P Corveto, P Damiani, F Di Micelli, A Pirrello, G Polimeni, G Altamonte, D Trsucello, V Capozza,

G Bommarito, F Fazio, G Venezia, G Puccio, S Frisella, R Lombardo, M Mannino

Ospedale Di Venere : A Bavaro, G Di Fiore, F del Re

Ospedale Vito Fazzi in Lecce : F Attolini, S Pede

Azienda Ospedaliera Universitaria Senese: P Priscitelli, R Tassi, G Martini, M Colaiacovo,

G Alicastro

Castiglione del Lago: E Righetti, C Sorace, P Pacini, C Rossi, M Peducci

San Camillo Forlanini Hospital: F Cuomo, A Marucci, L Mitello, L Casertano, F Pezzella,

A Amitrano

IRCCS Istituto Neurologico Nazionale Casimiro Mondino: A Cavallini , C Quaccini, G Laurito,

F Negri, S D’amico, M Bianchi

ICCS (Istitito Clinico Città Studi : S Baffa, C Tadeo, I Fele; G Randazzo

Ente Ospedaliero Ospedale Galliera : M Del Sette, F Micol

KAZAKHSTAN

Country Coordinator: S Medukhanova

Turkestan Regional Clinical Hospital : N Zharkinbekova, Y Akhmedova

Zhambyl Regional Hospital

Kokshetau Regional Hospital

LITHUANIA

Šiauliai Hospital: E Sigla

MOLDOVA

Country Coordinator: I Crivorucica

Institute of Neurology and Neurosurgery : E Costru-Tasnic, E Manole, A Filioglo

Institute of Medical Emergencies: Z Eremei, S Irina, C Barbu

POLAND

Country Coordinator: M Skrzypek-Czerko

Szpital Uniwersytecki nr 1 im. dr. A. Jurasza w Bydgoszczy: A Wiśniewski, K Filipska

SP ZOZ w Łukowie : R Kopala-Mazur, M Sondej

SP ZOZ w Przeworsku : A Kozak-Sykała, J Drąg

SP ZOZ w Skarżysku-Kamiennej : M Fudala, J Banaszewska

WWCOiT im Kopernika w Lodzi : B Adamkiewicz, I Wikło

Klinika Neurologii w Sandomierzu, Collegium Medicum Uniwersytet Jana Kochanowskiego w Kielcach : P Sobolewski, A Mędrykowska

Uniwersyteckie Centrum Kliniczne w Gdańsku: B Karaszewski, M Skrzypek-Czerko, D Buczkowski, M Kubach

107 Szpital Wojskowy SP ZOZ w Wałczu : I Koperska, G Szyszka, M Rogoziewicz

Specjalistyczny Szpital im. dr Alfreda Sokołowskiego w Wałbrzychu: P Marciniak, K Rojek,

A Wanago

 

PORTUGAL

Country Coordinator: S Salselas

ULSNE Macedo de Cavaleiros: N Ledesma, S Salselas, J Poço

ULS Guarda (Sousa Martin) : S Martins, H Pineros, M Abrantes, A Torres Nunes, D Rodrigues,

P Nobre

Hospital Dr Nelio Mendonca (Sesaram) : A Oliveira, S Andrade, R Rodriquez, J Pereira

Centro Hospitalar Leiria – Hospital Santo André : T Peralta, D Oliveira, E Araújo

CH Medio Ave - Santo Tirso (Famalicao): A Correia, F Carvalho Freitas, H Faria, M Costa,

D Morais

Centro Hospitalar Tamega e Sousa : S Queirós, B Rodrigues, E Barbosa, M Teixeira

ROMANIA

Spitalul Judetean de Urgenta Suceava : N Daniela, F Nadia-Simona

Spitalul Clinic Judetean de Urgenta Oradea : M Sabau, A Mărieș

Institutul Clinic Fundeni : A Dulămea, P Şerban

Spitalul Universitar de Urgenta Bucuresti : C Tiu, E Terecoasă, V Raţă, G Burlac,

RUSSIA

Stupinskaya Central District Clinical Hospital : V Anufrieva, E Jvaridze, O Tyutcheva

Magnitogorsk Iron&Steel Clinical Hospital : M Domashenko, T Vakin, M Loskutnikov

Scientific Research Institute of Emergency: I Voznyuk, M Prokhorova, I Chernyavsky, T Kharitonova

SLOVAKIA

Svet zdravia Nemocnica Topoľčany a.s. Pavlovova 17 : M Handulová, A Kadlicova

SPAIN

Country Coordinator: E Sanjuan

Hospital Universitario de Burgos : F Valiñas, MT Aguayo, I Domínguez, MT Almarza,

M Allende, AI Alonso,R Amo, G Arauzo, MA López, RM Barcena, MA Ortega, E Medrano,

RM Santana, E Rodríguez, MT Urbaneja, S Bravo, N Cortezón, N Elena, N García, AW Heras

M Trinidad Paniego, P López

Hospital Clinico Universitario de Valladolid : J Arenillas, B Gómez, M de Lera, FJ Reyes

Hospital Fundación Jiménez Diaz Spain : A García, I Navas

University Hospital Miguel Servet : C Villar, I Tercero, AL Noguera, H Tejada, J Marta

Hospital General de Segovia: A Álvarez, MF Zurdo,M Cuellar

Hospital Clinicas I Prov De Barcelona: J Gutiérrez, M López

Hospital del Mar : D Iglesias ,E Pascual,V Hidalgo, S García, AL Marques

Hospital Vall Hebron, Barcelona : E Sanjuan, O Pancorbo, K Santana, T Gutiérrez, L Calleja,

P Girón

Fundacion Alcorcon University Hospital : M Acevedo, D Guadarrama-Ortega, L López,

E Garcia, C Domingo

Hospital Universitario Virgen del Rocío: R Caro, A Valderrama, M García

Complejo Hospitalario Torrecardenas: JA García, C Martínez, N Madrid, E López

Hospital Ramon y Cajal : S Morel, MC Blazquez, A Cabrera, B Chavarino, M Esteban,

L Herrero, J Jimenex, L Marin, M Nuñez, M Ortega, R Ortiz, S Pindado, M Polo, JC Rodriguez,

C Romero, G Sanchez, O Sanchez, K Serrano, S de la Torre, S Torres, L Velasco del brio, M Zurita

Hospital Universitario y Politécnico La Fe, Valencia: C Hurtado, M Barberá, J Dominguez,

P Enguix, M Leiva, L Soler, M Torres

UKRAINE

Kharkiv Railway Hospital : V Lebedynets

Vinnytsia Regional Psychoneurological Hospital : S Moskovko, N Karpenko, N Tanasiienko,

T Visochanskaya, N Korobchuk, T Kostenko, A Visochanskiy, S Matiuk, T Kolomiets

Bila Tserkva City Clinical Hospital №2 : L Lypovenko, D Pohorilyi

UZBEKISTAN

Country Coordinator: M Bakhramov

Republic Scientific Centre of Emergency Care of Samarkand Branch : G Qizi

Tashkent City Clinical Hospital №4 named after I.Irgashev : M Bahramov, B Ugli, G Davronovich,

K Vladislavovna

Tashkent City Emergency Hospital: J Bakhadirovna , G Abdullaeva , D Faxraddinovich; M Nabiyevna

Tashkent City Emergency Hospital №7: K Ulugbekovich, K Georgiyevna, A Khikmatullaevich,

S Shirmatov 

European Liaison

M Rijksen

EUROPEAN STROKE ORGANISATION PRESIDENTS

M Dichgans, V Caso, B van der Worp

REGISTRY OF STROKE CARE QUALITY (RES-Q)

The International Clinical Research Center, St. Anne's University Hospital Brno: A Grecu, V Pasacek, R Mikulik, R Sedani, S Simsic, M Vařecha,

ANGELS

A Arjona, L Bazzani, M Bucher, A-M Butuc, S Fiorillo, R Havalda, D Hlebarska, A Kielkowska, K Pete, M Koneva. J Lakomá, K Lesna, L Beltrán Molina, T Moro, L Prystupiuk, K Putylo, C Queiroga,

S Ripamonti, R Rodrigues, E Rodríguez, E Salvati, L Spagnuolo, C Stanciu, M Stolarczyk, A Tolmachev, A Tymecka-Woszczerowicz, D Urbani, Y Vadziuk, B Velazquez, T Zabashta

NURSING RESEARCH INSTITUTE (NRI)

T Doyle, O Fasugba, J Israel, C Martinez, C Parker, P Zenonos

If you would like to get in contact with us, please email QASC@acu.edu.au

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