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.

"Implementing evidenced-based interventions into practice and changing clinical behaviour is challenging, but has been achieved by ACU's Nursing Research Institute."
Professor Sandy Middleton
Professor of Nursing and Director of the Nursing Research Institute

The QASC trial has won a series of awards including:

  • Commonwealth Health Minister and Australian College of Nursing Inaugural Nursing Trailblazer Finalist, 2019
  • NSW Premier's Public Sector Award for Improving Performance and Accountability, 2014
  • NSW Health Excellence in Nursing and Midwifery Award (Excellence in Innovation), 2014
  • Canadian Stroke Congress Award for Impact, 2011
  • American Heart Association Council on Cardiovascular Nursing, Stroke Article of the year, 2012

It was also included in the Faculty of 1000 Library (top two per cent of international articles—biology and medical research).

Learn more about the QASC trial

Lead researchers 

Professor Sandy Middleton

Professor of Nursing and Director of the Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University

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Simeon Dale

Clinical Research Fellow, Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University

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Impact summary

An infographic research summary of the impacts of this research is available below.

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Engagement and impact assessment 2018

ACU submitted this research as an Impact study in the 2018 ARC Engagement and Impact (EI) 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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