TY - JOUR
T1 - Improving stroke Emergency Department nursing care
T2 - The Code Stroke 2.0 pre-test/post-test feasibility study
AU - Jones, Brett
AU - Fasugba, Oyebola
AU - Dale, Simeon
AU - Burrows, Chris
AU - John, Manju
AU - Doncillo, Mary
AU - Wright, Simogne
AU - Lueck, Christian
AU - D'Este, Catherine
AU - McElduff, Ben
AU - McInnes, Elizabeth
AU - Middleton, Sandy
N1 - Publisher Copyright:
© 2023 Australian College of Nursing Ltd
PY - 2023/10
Y1 - 2023/10
N2 - Background: Activation of an acute ‘Code Stroke’ pathway on hospital arrival improves thrombolysis rates. Whilst post-stroke protocols to manage fever, hyperglycaemia, and dysphagia (Fever, Sugar and Swallow (FeSS) Protocols) have been shown to reduce death and dependency, facilitated implementation in Emergency Department (ED) has been difficult. Aim: To evaluate if an expanded role for an Acute Stroke Nurse improves Code Stroke activation, increases FeSS Protocol uptake in ED, and results in faster stroke unit transfer. Methods: A pre-test/post-test feasibility study undertaken in an Australian ED. Intervention comprised an expanded Acute Stroke Nurse role who instigated FeSS Protocol care or supported ED clinicians to use the protocols. Logistic regression analyses compared outcomes pre-test/post-test intervention. Subgroup analysis examined intervention effect during business hours. Findings: There were 117 patients each in the pre-intervention and post-intervention cohorts (n = 234). Post-intervention patients had significantly more Code Stroke activations (pre: 7%, post: 62%), temperature at ED arrival (pre: 62%, post: 78%), formal blood glucose (pre: 55%, post: 98%), fewer oral medications administered before swallow screening (pre: 31%, post: 14%), more stroke unit transfers within 4 h from ED arrival (pre: 26%, post: 41%), and thrombolysis screening (pre: 53%, post: 80%). Subgroup analysis during business hours showed significant improvement in Code Stroke activations (pre: 10%, post: 79%), formal blood glucose testing (pre: 57%, post: 98%), reduced oral medications before swallow screening (pre: 24%, post: 9%), and thrombolysis screening (pre: 45%, post: 82%). Conclusion: Expanding the Acute Stroke Nurse role to support ED staff during Code Stroke was associated with improved stroke care processes. Our findings highlight potential for successful implementation of this model across multiple hospitals to improve patient outcomes.
AB - Background: Activation of an acute ‘Code Stroke’ pathway on hospital arrival improves thrombolysis rates. Whilst post-stroke protocols to manage fever, hyperglycaemia, and dysphagia (Fever, Sugar and Swallow (FeSS) Protocols) have been shown to reduce death and dependency, facilitated implementation in Emergency Department (ED) has been difficult. Aim: To evaluate if an expanded role for an Acute Stroke Nurse improves Code Stroke activation, increases FeSS Protocol uptake in ED, and results in faster stroke unit transfer. Methods: A pre-test/post-test feasibility study undertaken in an Australian ED. Intervention comprised an expanded Acute Stroke Nurse role who instigated FeSS Protocol care or supported ED clinicians to use the protocols. Logistic regression analyses compared outcomes pre-test/post-test intervention. Subgroup analysis examined intervention effect during business hours. Findings: There were 117 patients each in the pre-intervention and post-intervention cohorts (n = 234). Post-intervention patients had significantly more Code Stroke activations (pre: 7%, post: 62%), temperature at ED arrival (pre: 62%, post: 78%), formal blood glucose (pre: 55%, post: 98%), fewer oral medications administered before swallow screening (pre: 31%, post: 14%), more stroke unit transfers within 4 h from ED arrival (pre: 26%, post: 41%), and thrombolysis screening (pre: 53%, post: 80%). Subgroup analysis during business hours showed significant improvement in Code Stroke activations (pre: 10%, post: 79%), formal blood glucose testing (pre: 57%, post: 98%), reduced oral medications before swallow screening (pre: 24%, post: 9%), and thrombolysis screening (pre: 45%, post: 82%). Conclusion: Expanding the Acute Stroke Nurse role to support ED staff during Code Stroke was associated with improved stroke care processes. Our findings highlight potential for successful implementation of this model across multiple hospitals to improve patient outcomes.
KW - Blood glucose
KW - Dysphagia
KW - Emergency Department
KW - Fever
KW - Nurse specialist
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=85163409296&partnerID=8YFLogxK
U2 - 10.1016/j.colegn.2023.04.002
DO - 10.1016/j.colegn.2023.04.002
M3 - Article
SN - 1322-7696
VL - 30
SP - 736
EP - 743
JO - Collegian
JF - Collegian
IS - 5
ER -