Death, dependency and health status 90 days following hospital admission for acute stroke in NSW

Abstract

In this pre-intervention cohort of selected acute stroke inpatients, stroke severity was mild to moderate and subsequent clinical outcomes were favourable in the majority. The findings from this study provide a comprehensive description of 90-day health outcomes of patients who have experienced a mild-moderate stroke managed in stroke care units across metropolitan NSW and provide valuable data to inform the subsequent cluster trial.

The effectiveness of knowledge translation interventions for promoting evidence-informed decision-making among nurses in tertiary care: a systematic review and meta-analysis

“…Middleton and colleagues [ 36 , 64 , 65 ] implemented of a multifaceted intervention to implement clinical treatment protocols based on a clinical practice guideline in acute stroke units which demonstrated small effects for a number of client outcomes, of which the reduction in death and dependency was clinically important. Compared to clients receiving care from healthcare professionals who received access to the guideline only and clients cared for by healthcare professionals (including nurses) receiving the intervention, there was evidence of a reduction in mean temperature (°C) [MD 0.09, 95 % CI (0.04, 0.15), P = 0.001], the risk of temperature greater than 37.5 °C [RR, 0.64; 95 % CI (0.51, 0.81), P ≤ 0.0001; RR and 95 % CI calculated by review team], and mean glucose [MD 0.54, 95 % CI (0.08, 1.01), P = 0.02] during the first 72 h in an acute stroke unit, as well as reduction in the risk of death or dependence [RR 0.72, 95 % CI 0.65, 0.84, P < 0.002; RR and 95 % CI calculated by review team] and an increase in physical health [MD 3.4, 95 % CI (1.2, 5.5), P = 0.002].…”

Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): a cluster randomised controlled trial

“…Data for the pre-intervention patient cohort have been published. 10 Age, sex, 90-day death, 90-day death and dependency, 90-day functional dependency (BI) and health status (PCS score and MCS score) were similar for the intervention and control groups. and time between onset of stroke symptoms and arrival at ASU were similar for patients in the intervention and control groups although fulltime employment appeared slightly lower in the control group.…”

“…7 Care is not always consistent with these recommendations however. 6,8 We designed the Quality in Acute Stroke Care (QASC) study, a cluster randomised controlled trial (CRCT), 9,10 to evaluate the effect on 90-day post-stroke patient outcomes of multidisciplinary team building workshops and a standardised interactive education program to implement evidence-based treatment protocols for the management of fever, hyperglycaemia and swallowing dysfunction. These three parameters were selected because they involve multidisciplinary teamwork, which has been demonstrated to improve healthcare processes and patient outcomes, 11 a priority for stroke care.…”

Effect of Telestroke on Emergent Stroke Care and Stroke Outcomes

“…The key elements of evidence-based stroke unit care, such as monitoring and treating the occurrence of raised temperature, abnormal blood glucose levels, and dysphagia status, can be delivered. 38 The ideal scenario is that only appropriate patients are transferred to hub hospitals and other patients are kept in the spoke hospitals, thereby meeting a definition of quality by the Agency of Health Research and Quality in the United States: "doing the right thing, at the right time, in the right way, for the right person." 39 The benefits of the telestroke unit concept need to be balanced against the clinical limitations of stroke telemedicine (eg, conducting a complete neurological examination, staff and patient uncertainty with the technology, or conducting difficult discussions such as end-of-life decisions).…”