https://novaprd-lb.newcastle.edu.au/vital/access/manager/Index en-au 5 https://novaprd-lb.newcastle.edu.au/vital/access/manager/Repository/uon:29929 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.]]> Wed 15 Dec 2021 16:10:19 AEDT ]]> https://novaprd-lb.newcastle.edu.au/vital/access/manager/Repository/uon:48570 Tue 21 Mar 2023 18:40:40 AEDT ]]> https://novaprd-lb.newcastle.edu.au/vital/access/manager/Repository/uon:21404 n=3467, mean age 74 years [standard deviation 13], 50% female; intracerebral haemorrhage n=275, mean age 74 years [standard deviation 13], 48% female). Following multivariable analyses patients with intracerebral haemorrhage were less likely to be admitted to a stroke unit (adjusted odds ratio 0·65; 95% confidence interval 0·45-0·94) or receive an assessment from allied health (adjusted odds ratio 0·54; 95% confidence interval 0·33-0·89) than patients with ischemic stroke. Patients with intracerebral haemorrhage are also less likely to be independent (adjusted odds ratio 0·36; 95% confidence interval 0·3-0·5) at time of hospital discharge and had a greater odds of dying in hospital (adjusted odds ratio 2·1; 95% confidence interval 1·3-3·5). Patients that were admitted to a stroke unit had a greater odds of being independent (modified Rankin Score 0-2) at day 7-10 irrespective of stroke type or severity on admission (adjusted odds ratio 1·3; 95% confidence interval 1·01-1·66). Conclusions: Following intracerebral haemorrhage, patients were less likely to be admitted to an acute stroke unit and receive allied health interventions. Admission to stroke units improved the likelihood of being independent at days 7-10 and, therefore, more should be done to encourage evidence-based care for intracerebral haemorrhage.]]> Sat 24 Mar 2018 08:04:59 AEDT ]]> https://novaprd-lb.newcastle.edu.au/vital/access/manager/Repository/uon:19904 Sat 24 Mar 2018 08:03:48 AEDT ]]> https://novaprd-lb.newcastle.edu.au/vital/access/manager/Repository/uon:28765 P<0.15 or if considered clinically important and readmission status. Results: Among 3328 patients, 6.5% were readmitted within 28 days (mean age, 75; 48% female; 92% ischemic). After bivariate analyses 14/43 factors from 4/5 categories were associated with readmission after hospitalization for stroke. Two factors from patient and health outcome categories remained independently associated with readmission after multivariable analyses. These were dependent premorbid functional status (adjusted odds ratio, 1.87; 95% confidence interval, 1.25–2.81) and having a severe adverse event during the initial hospitalization for stroke (adjusted odds ratio, 2.81; 95% confidence interval, 1.55–5.12). Conclusions: This is the first study to comprehensively evaluate factors associated with 28-day readmission after stroke. The factors associated with 28-day readmission are diverse and include potentially modifiable and nonmodifiable factors.]]> Sat 24 Mar 2018 07:24:50 AEDT ]]> https://novaprd-lb.newcastle.edu.au/vital/access/manager/Repository/uon:16768 Mon 26 Nov 2018 15:27:36 AEDT ]]>