Greater adherence in fever, hyperglycaemia, and swallowing (FESS) management for patients with acute stroke across Australia: An observational study.

Abstract

Background: In the Quality in Acute Stroke Care (QASC) trial, nurse-led protocols to manage fever, hyperglycaemia and swallowing (FeSS) improved outcomes for patients with stroke. Aim(s): To assess: 1) adherence to FeSS elements over time in Australian hospitals delivering acute stroke care; 2) whether hospitals in New South Wales (NSW), where the initial trial and subsequent active dissemination of the intervention were undertaken, have greater improvement in adherence compared to the rest of Australia. Method(s): Cross-sectional, clinical audit data from the National Stroke Acute Services Audits 2013, 2015 and 2017. Mixed effects logistic regression of a composite outcome reflecting compliance with all FeSS elements included audit year (Aim 1) and audit year by location (NSW vs other) interaction term (Aim 2). Result(s): In 2013: 3,741 audits (124 hospitals); 2015: 4,087 audits (112 hospitals) and 2017: 4,192 audits (117 hospitals). Nationally, the odds of receiving all FeSS elements in 2017 was significantly higher than 2013 (OR 1.8 95% CI 1.6, 2.0), with greatest uptake between 2015-2017 (OR 1.6 95% CI 1.4, 1.7). Improvement over time was significantly greater in NSW than other hospitals (p<0.001); OR 2017 relative to 2013: NSW: 2.9 (95% CI 2.3, 3.7); other: 1.3 (95% CI 1.1, 1.6). Conclusion(s): An 80% increase in odds of adherence to FeSS elements nationally since 2013 was evident, with greater improvements in NSW hospitals where the initial trial and following support for implementation was undertaken. Further uptake of the FeSS elements is anticipated after inclusion in the 2017 national guidelines.