Invited Speaker Australian and New Zealand Stroke Organisation Conference 2025

Fess up: are we following protocols? QASC Australasia trial vs national stroke care reality (123099)

Oyebola Fasugba 1 2 , Simeon Dale 1 2 , Kelly Coughlan 1 2 , Elizabeth McInnes 1 2 , Dominique Cadilhac 3 4 , N Wah Cheung 5 , Kelvin Hill 6 , Kirsty Page 7 , Estela Sanjuan Menendez 8 , Emily Neal 9 , Vivien Pollnow 7 , Eileen Gilder 10 , Julia Slark 10 , Anna Ranta 11 12 , Christopher Levi 9 13 , Jeremy Grimshaw 14 15 , Sandy Middleton 1 2
  1. Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne and Australian Catholic University, Sydney, New South Wales, Australia
  2. School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, New South Wales, Australia
  3. Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
  4. Stroke theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
  5. Centre for Diabetes and Endocrinology Research, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia
  6. Stroke Foundation, Sydney, New South Wales, Australia
  7. St Vincent’s Health Network Sydney, Sydney, New South Wales, Australia
  8. Vall d’Hebron Hospital Universitari , Barcelona, Catalonia, Spain
  9. John Hunter Hospital, Newcastle, New South Wales, Australia
  10. School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
  11. Department of Medicine, University of Otago, Wellington, New Zealand
  12. Department of Neurology, Wellington Hospital, Wellington, New Zealand
  13. Department of Medicine, University of Newcastle, Newcastle, New South Wales, Australia
  14. Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  15. Methodological and Implementation Research Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

Background and aims: The Quality in Acute Stroke Care (QASC) Research Program utilises implementation strategies to empower clinicians to use protocols for managing fever, hyperglycaemia (sugar) and swallowing (FeSS). Persistent gaps remain in FeSS Protocol adherence based on data from the National Acute Stroke Audits (2013-2023). The QASC Australasia Trial is evaluating the required dose of facilitation to improve implementation. We analysed baseline trial data (2022–2025) from 45 hospitals and audit data (2023) from 107 hospitals to compare protocol adherence and characteristics between cohorts.

Methods: FeSS variables compared: 1) paracetamol <1 hour of first temperature >37.5°C; 2) insulin <1 hour of blood glucose level (BGL) >10mmol/L; and 3) swallow screen (<4 hours, <24 hours and before food, fluids or oral medication). Trial and audit hospitals were compared by remoteness and stroke unit presence.

Results: Baseline adherence appeared lower in trial hospitals for variables 1 (42% trial vs 44% audit) and 2 (23% trial vs 27% audit). However, for variable 3, adherence appeared higher (<4 hours: 33% trial vs 27% audit; <24 hours: 64% trial vs 60% audit; before oral intake: 64% trial vs 60% audit). Hospitals were in major cities (60% trial vs 54% audit) and had stroke units (90% trial vs 80% audit).

Conclusion: FeSS Protocol adherence and hospital characteristics were broadly similar between trial and audit hospitals, and not clinically significant. These findings suggest good baseline comparability and highlight that in routine practice, protocol adherence remains suboptimal, reinforcing the need for targeted implementation strategies to improve adherence.