The Quality in Acute Stroke Care (QASC) Trial showed that multidisciplinary, evidence-based, nurse-led interventions to manage fever, hyperglycaemia and swallowing following stroke significantly improved outcomes. Results, published in the Lancet, demonstrated that supported implementation of Fever, Sugar, and Swallow  (FeSS) Protocols decreased 90-day death and dependency by 16% (p=0.002), reduced in-hospital temperatures over the first 72 hours (p=0.001), glucose levels (p=0.02), improved swallowing management (p=<0.001), and had a clinically-important two-day length of stay reduction even though this was not statistically significant (p>0.144).1

Partnering with the New South Wales Agency for Clinical Innovation and the Stroke Foundation, we were tasked to ‘scale-up and spread’ the QASC program to all 36 stroke services in New South Wales. Using a pre-test/ post-test study design, we significantly increased the proportion of patients who received care according to the FeSS Protocols.2

Professor Sandy Middleton, Professor Dominique Cadilhac, Simeon Dale, James Dunne, Dan Comerfield, Mark Longworth, Anne Lydtin, Jeanette Ward.
Professor Dominique Cadilhac, Professor N Wah Cheung, Simeon Dale, Dr Peta Drury, Professor Cate D’Este , Professor Jeremy Grimshaw, Kelvin Hill, Eva Katalinic, Professor Christopher Levi, Mark Longworth, Anne Lydtin, Professor Sandy Middleton, Elizabeth O’Brien, Sigrid Patterson, Clare Quinn, Fiona Ryan, Melissa Tinsley, Sonia Wutzke.
Professor Dominique Cadilhac, Simeon Dale, Nancy Dixon, Kelvin Hill, Dr Anna Lydtin, Simeon Dale.
Armidale Hospital
Bankstown Hospital
Bathurst Base Hospital
Belmont Hospital
Blacktown Hospital
Bowral Hospital
Broken Hill Base Hospital
Campbelltown Hospital
Coffs Harbour Base Hospital
Concord Hospital
Dubbo Base Hospital
Fairfield Hospital
Gosford Hospital
Hornsby Hospital
John Hunter Hospital
Lismore Base Hospital
Liverpool Hospital
Maitland Base Hospital
  1. Middleton S, McElduff P, Ward J, Grimshaw JM, Dale S, D'Este C, Drury P, Griffiths R, Cheung NW, Quinn C, Evans M, Cadilhac D & Levi C. Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): a cluster randomised controlled trial. The Lancet 2011;378 (9804):1699-706.2
  1. Middleton S, Lydtin A, Comerford D on behalf of the QASCIP Working Group and Steering Committee, et al. From QASC to QASCIP: successful Australian translational scale-up and spread of a proven intervention in acute stroke using a prospective pre-test/post-test study design. BMJ Open 2016;6:e011568.

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