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

Fever, Hyperglycaemia (Sugar) and Swallowing (FeSS) Management in Stroke Unit and Non-stroke Unit Hospitals: A sub study of the QASC Europe Project (#56)

Ranran Ding 1 , Vasiliki Betihavas 2 , Benjamin McElduff 3 4 , Simeon Dale 3 4 , Kelly Coughlan 3 4 , Elizabeth McInnes 3 4 , Sandy Middleton 3 4 , Oyebola Fasugba 3 4
  1. Australian Catholic University, Melbourne, Victoria, Australia
  2. School of Nursing and Midwifery, The University of Notre Dame Australia, Sydney, New South Wales, Australia
  3. Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne and Australian Catholic University, Sydney, New South Wales, Australia
  4. School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, New South Wales, Australia

Background: Stroke unit care reduces patient morbidity and mortality. The Quality in Acute Stroke Care (QASC) Europe Project achieved significant large-scale translation of nurse-initiated protocols to manage Fever, hyperglycaemia (Sugar) and Swallowing (FeSS) in 64 hospitals across 17 European countries. However, FeSS management in stroke unit and non-stroke unit European hospitals requires examination.

Aim: To compare FeSS Protocol adherence in stroke unit versus non-stroke unit European hospitals.

Methods: An observational study using the QASC Europe Project post-implementation audit data was undertaken. Stroke unit and non-stroke unit hospitals were categorised using the four National Acute Stroke Services Framework criteria, collected from an organisational survey. Differences in FeSS Protocol adherence between stroke unit and non-stroke unit hospitals were investigated using mixed-effects logistic regression, adjusting for age, sex and NIHSS.

Results: Of the 56 hospitals from 16 countries providing organisational survey data, 34 (61%) met all stroke unit criteria, contributing data for 1825 (64%) of 2871 patients. Of the remaining 22 (39%) hospitals, 17 (77%) met three of the four stroke unit criteria. There were no differences between hospitals with a stroke unit and those without for post-implementation adherence to: Fever (49% stroke unit vs 57% non-stroke unit, OR:0.400, 95%CI: 0.087, 1.844, P=0.240); Hyperglycaemia (50% stroke unit vs 57% non-stroke unit, OR:0.403, 95%CI: 0.087, 1.856, P=0.243); Swallow (75% stroke unit vs 60% non-stroke unit, OR:1.702, 95%CI: 0.643, 4.502, P=0.284) or overall FeSS Protocol (36% stroke unit vs 36% non-stroke unit, OR:0.466, 95%CI: 0.106, 2.043, P=0.311).

Conclusion: FeSS Protocol adherence was similar in stroke unit and non-stroke unit hospitals, likely due to most non-stroke unit hospitals meeting some stroke unit criteria and their ease of use. While stroke unit care is the gold standard, application of these protocols by all hospitals regardless of stroke unit status, extends the reach for improving stroke care quality.