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New nurse-led protocols for stroke patients, based on ACU research, led by the Nursing Research Institute, have resulted in changes to policy, guidelines and clinical practice across the globe. The protocols were developed through the Quality in Acute Stroke Care (QASC) Trial (published in the Lancet, 2011) to manage fever, hyperglycaemia and swallowing (FeSS) post-stroke.
Previous research had shown that patients with FeSS difficulties experienced higher rates of death and disability following a stroke than those without these symptoms. The improved approaches tested by the ACU researchers to manage FeSS difficulties in the first 72 hours of hospitalisation following stroke significantly reduced mortality and disability and resulted in shorter hospital stays. An economic evaluation also demonstrated potential to reduce healthcare costs.
In Australia, the FeSS indicators are now part of the Australian Stroke Clinical Registry voluntary indicator set. The team is currently undertaking the QASC Europe Project, implementing the protocols in 14 European countries.
Lead researcher, Professor Sandy Middleton, Professor of Nursing and Director of the Nursing Research Institute said many of the countries covered by the project were located in Eastern Europe.
“Stroke care is often rudimentary in Eastern Europe with poor or no access to reperfusion therapy, so use of the FeSS protocols for stroke patients could make a big difference in reducing death and dependency in these countries” she said.
“The team is also exploring the feasibility of ‘QASC Global’—a translational study to demonstrate further improvements and sustainability of the FeSS intervention within Australia, and upscale the intervention into other hospitals internationally.
“To date, 75 hospitals in 27 non-European countries have filled in expressions of interest to be involved in QASC Global.”
The protocols have been adopted by healthcare and supporting services in Australia and have informed the development of guidelines in the United Kingdom.
The QASC trial has won a series of awards including:
It was also included in the Faculty of 1000 Library (top two per cent of international articles—biology and medical research).
Change that improves health and well-being outcomes in society.
QASC Trial results, published in the Lancet (2011), showed that patients who were cared for in stroke units that received supported implementation of FeSS protocols had:
Change in economic participation and activity.
Independent economic evaluation of FeSS protocols and behaviour change showed that if 65 per cent of eligible Australian stroke patients were managed with these protocols, over a 12 month period there would be a saving of $281 million.
Change in professional behaviour and standards within a sector.
Change in policy, organisational structure and formal processes.
New technology, tools, software and design that improves people's lives.
The person, people or organisations directly impacted by this research.
National
ACU submitted this research as an impact study in the 2018 ARC Engagement and Impact Assessment. The research received the rank of 'High', meaning the impact made a highly significant contribution to economy, society, environment, or culture, beyond the contribution to academic research.
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Professor Sandy Middleton
Professor of Nursing and Director, Nursing Research Institute
St Vincent’s Health Australia (Sydney) and ACU
Simeon Dale
Clinical Research Fellow, Nursing Research Institute
St Vincent’s Health Australia (Sydney) and ACU
The NRI brings together researchers and clinicians to conduct clinically relevant research. The NRI specialises in implementation science research examining ways to promote evidence translation in the areas of stroke management, hospital-acquired complications, and de-implementation of low-value nursing care.
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