Quality in Acute Stroke Care (QASC): process evaluation of an intervention to improve the management of fever, hyperglycemia, and swallowing dysfunction following acute stroke

BackgroundOur randomized controlled trial of a multifaceted evidence‐based intervention for improving the inpatient management of fever, hyperglycemia, and swallowing dysfunction in the first three‐days following stroke improved outcomes at 90 days by 15%. We designed a quantitative process evaluation to further explain and illuminate this finding. MethodsBlinded retrospective medical record audits were undertaken for patients from 19 stroke units prior to and following the implementation of three multidisciplinary evidence‐based protocols (supported by team‐building workshops, and site‐based education and support) for the management of fever (temperature ≥37·5°C), hyperglycemia (glucose >11 mmol/l), and swallowing dysfunction in intervention stroke units. ResultsData from 1804 patients (718 preintervention; 1086 postintervention) showed that significantly more patients admitted to hospitals allocated to the intervention group received care according to the fever (n = 186 of 603, 31% vs. n = 74 of 483, P ≤ 0·001), hyperglycemia (n = 398 of 603, 66% vs. n = 217 of 483, 45%, P ≤ 0·001), and swallowing dysfunction protocols (n = 288 of 603, 48% vs. n = 126 of 483, 26%, P = 0·04). Significantly more patients in these intervention stroke units received four‐hourly temperature monitoring (n = 222 of 603, 37% vs. n = 90 of 483, 19%, P ≤ 0·001) and six‐hourly glucose monitoring (194 of 603, 32% vs. 46 of...
Source: International Journal of Stroke - Category: Neurology Authors: Tags: Research Source Type: research