The T3 Trial: Triage, Treatment and Transfer of patients with stroke in emergency departments.

Abstract

Background & Aims: The T3 cluster randomised trial aimed to improve Triage, Treatment and Transfer (T3) of patients with acute stroke in emergency departments (EDs). Method(s): Our prospective, multicentre, parallel group, cluster randomised trial with blinded outcome assessment, randomised EDs 1:1 to receive either the T3 intervention or no support (control EDs). Our evidence-based intervention targeted: (1) Triage: patients with suspected stroke assigned to Australian Triage Scale category 1 or 2 (seen within 10 minutes); (2) Treatment: screening for tPA eligibility and administration of tPA where applicable; protocols for management of fever, hyperglycaemia and swallowing; and (3) rapid Transfer from ED to the stroke unit, implemented using (i) workshops to determine barriers and solutions; (ii) education; (iii) use of clinical opinion leaders; (iv) email, telephone and site visit reminders. Primary Outcome: 90-days post-admission death or dependency (mRS>2). Secondary Outcomes: 90-day: health status (SF-36), functional dependency (Barthel Index), quality of life (EQ-5D); and in-hospital quality-of-care outcomes: triage practices; monitoring and management for thrombolysis, fever, hyperglycaemia, swallowing; and transfer practices. Result(s): Of the 26 eligible sites from three states and one territory in Australia, all (100%) agreed to participate with 2253 patients consenting (pre-implementation n=645; post-implementation n=1608). Of these, 1879 will be analysed (pre-implementation n=574; post-implementation n=1305). In the post-implementation cohort, 751 patients were randomised to the intervention group and 554 to the control group. Data currently are being analysed. Conclusion(s): This large trial will provide rigorous evidence for assisted implementation of nurse-initiated ED stroke protocols aiming to improve outcomes for patients with stroke.