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
Objectives To embed an evidence based intervention to manage FEver, hyperglycaemia (Sugar) and Swallowing (the FeSS protocols) in stroke, previously demonstrated in the Quality in Acute Stroke Care (QASC) trial to decrease 90 day death and dependency, into all stroke services in New South Wales (NSW) Australia's most populous state. Design Pre test/post test prospective study. Setting 36 NSW stroke services. Methods Our clinical translational initiative, the QASC Implementation Project (QASCIP) targeted stroke services to embed 3 nurse led clinical protocols (the FeSS protocols) into routine practice. Clinical champions attended a 1 day multidisciplinary training workshop and received standardised educational resources and ongoing support. Using the National Stroke Foundation audit collection tool and processes, patient data from retrospective medical record self reported audits for 40 consecutive patients with stroke per site pre QASCIP (1 July 2012 to 31 December 2012) were compared with prospective self reported data from 40 consecutive patients with stroke per site post QASCIP (1 November 2013 to 28 February 2014) Inter rater reliability was substantial for 10 of 12 variables. Primary outcome measures Proportion of patients receiving care according to the FeSS protocols pre QASCIP to post QASCIP. Results All 36 (100% NSW stroke services participated, nominating 100 site champions who attended our educational workshops. The time from start of intervention to completion of post QASCIP data collection was 8 months. All (n=36, 100% sites provided medical record audit data for 2144 patients (n=1062 pre QASCIP; n=1082 post QASCIP) Pre QASCIP to post QASCIP, proportions of patients receiving the 3 targeted clinical behaviours increased significantly: management of fever (pre: 69% post: 78% p=0.003) hyperglycaemia (pre: 23% post: 34% p=0.0085) and swallowing (pre: 42% post: 51% p=0.033) Conclusions We obtained unprecedented statewide scale up and spread to all NSW stroke services of a nurse led intervention previously proven to improve long term patient outcomes. As clinical leaders search for strategies to improve quality of care, our initiative is replicable and feasible in other acute care settings.
BMJ Open