title: 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.
abstract: 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.
  
  
  
  Pre-test/post-test prospective study.
  
  
  
  36 NSW stroke services.
  
  
  
  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.
  
  
  
  Proportion of patients receiving care according to the FeSS protocols pre-QASCIP to post-QASCIP.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, Sydney, New South Wales, Australia.
authors.forename: Sandy
authors.identifier: 0000-0002-7201-4394
authors.initials: S
authors.lastname: Middleton
authors.affiliation: Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, Sydney, New South Wales, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Lydtin
authors.affiliation: NSW Agency for Clinical Innovation, Chatswood, New South Wales, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Comerford
authors.affiliation: Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.
authors.forename: Dominique A
authors.initials: DA
authors.lastname: Cadilhac
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Patrick
authors.initials: P
authors.lastname: McElduff
authors.affiliation: Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, Sydney, New South Wales, Australia.
authors.forename: Simeon
authors.initials: S
authors.lastname: Dale
authors.affiliation: National Stroke Foundation, Melbourne, Victoria, Australia.
authors.forename: Kelvin
authors.initials: K
authors.lastname: Hill
authors.affiliation: Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Longworth
authors.affiliation: University of Notre Dame, Broom Campus, Broome, Western Australia, Australia University of Ottawa, Ottawa, Canada.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Ward
authors.affiliation: Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia University of Sydney, Sydney, New South Wales, Australia.
authors.forename: N Wah
authors.initials: NW
authors.lastname: Cheung
authors.affiliation: National Centre for Epidemiology and Population Health (NCEPH), Australian National University, Canberra, Australian Capital Territory, Australia.
authors.forename: Cate
authors.initials: C
authors.lastname: D'Este
mesh_terms: D002985:Clinical Protocols; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology*; D019317:Evidence-Based Medicine; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000503:physiopathology*; D008485:Medical Audit; D009517:New South Wales; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011787:Quality of Health Care; D015203:Reproducibility of Results; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology
keywords: Nursing care; bundle; implementation