Platform Presentation The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Does a ‘Strong recommendation’ within a clinical practice guideline change clinician behaviour? National uptake of Fever, hyperglycaemia (Sugar) and Swallowing (FeSS) management following stroke. (#7)

Kelly Coughlan 1 2 , Benjamin McElduff 1 2 , Simeon Dale 1 2 , Oyebola Fasugba 1 2 , Dominique A Cadilhac 3 4 , Kelvin Hill 5 , Monique Kilkenny 3 4 , Tara Purvis 3 , Megan Reyneke 3 , Elizabeth McInnes 1 2 , Sandy Middleton 1 2
  1. Nursing Research Institute , St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne and Australian Catholic University, Sydney,Melbourne, VIC,NSW, Australia
  2. School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW, Australia
  3. Stroke and Ageing Research, School of Clinical Sciences , Monash Health, Monash University, Melbourne, VIC, Australia
  4. Stroke Theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
  5. Stroke Foundation, Melbourne, VIC, Australia

Background:

The Quality in Acute Stroke Care (QASC) Trial demonstrated that protocols to manage Fever, hyperglycaemia (Sugar) and Swallowing (FeSS) post-stroke reduce death and disability. Subsequently, in 2017, a ‘Strong Recommendation’ to support their use was included in the Australian Clinical Guidelines for Stroke Management.

Aims:

To compare FeSS Protocol adherence in Australian hospitals before and after recommendations included in the Australian stroke guidelines; and to assess adherence in hospitals previously participating in FeSS Intervention studies (QASC Research Program).

 

Methods:

Cross-sectional study using Stroke Foundation Acute Service Audit data. Adherence was compared for 2015 and 2017 (pre-guideline) against 2019 and 2021 (post-guideline); and for hospitals who participated in any of the FeSS Intervention studies. Primary outcome: a composite measure for adherence to all FeSS process variables (n=6, i.e., treatment and management for fever, hyperglycaemia, swallowing). Mixed-effects logistic regression, with a random intercept for hospital, adjusted for stroke type, age, sex, and interaction between guideline inclusion and previous participation in a FeSS intervention study.

 

Results:

In total,112 hospitals contributed data to at least one audit cycle for both periods (pre=7011, post=7195). An improvement in overall FeSS Protocol adherence was evident post-guideline inclusion (Pre: 35% vs Post 40%, OR:1.17, 95%CI: 1.06, 1.30). Previous participation in a FeSS intervention study was associated with higher FeSS Protocol adherence (OR:1.57, 95%CI: 1.22, 2.02). Patients with haemorrhagic stroke were less likely to receive care according to all FeSS Protocols compared with patients with ischaemic stroke (OR: 0.69, 95%CI: 0.61, 0.78).

 

Conclusion:

Overall, there is evidence there has been an improvement in FeSS Protocol adherence following a strong recommendation for their use in the Australian stroke guidelines. Improved adherence for hospitals who previously participated in a FeSS Intervention study suggests active efforts provide greater implementation outcomes. Further nationwide implementation of FeSS Protocols in Australian hospitals is warranted.