Fever, Hyperglycaemia (Sugar), Swallow (FeSS) Protocols use in Australian hospitals. Analysis of national stroke data and clinician perspectives of critical factors that influence their use.

Fever, Hyperglycaemia (Sugar), Swallow (FeSS) clinical guidelines adherence. Analysis of national Stroke Foundation audit and Australian Stroke Clinical Registry (AuSCR) data and qualitative interviews with clinicians regarding their perspectives on critical factors that influence FeSS Protocol adherence.

Status

Completed

Phases

Unknown

Study type

Observational

Source

ANZCTR

Registry ID

ACTRN12623000445673

Acronym

n/a

Enrollment

Registered

2023-05-01

Start date

2023-09-21

Completion date

2024-01-15

Last updated

2025-09-08

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

None listed

Brief summary

Clinical protocols to manage three common complications after stroke (Fever, hyperglycaemia (Sugar) and Swallowing problems [FeSS protocols]) was shown to reduce death and disability by 15.7% for patients in the Quality in Acute Stroke Care Trial. As a result of this trial, a ‘Strong Recommendation’ to support use of the FeSS Protocols was included in the 2017 Clinical Guidelines for Stroke Management. Before the new guideline recommendation there was a significant evidence to practice gap with only 41% of patients receiving care according to the FeSS Protocols in Australian hospitals. Outside of the FeSS Intervention trials, there has been no nationwide systematic implementation efforts to introduce FeSS protocols. The aim of this research is to determine adherence to the FeSS Protocols since their inclusion as recommended care in the 2017 National Acute Stroke Guidelines. Secondary aims of this research are to: i) determine if participation in any of the previous FeSS Intervention studies (QASC, QASCIP or T3 Trial) improved adherence with the FeSS Protocols when compared with hospitals who did not participate; ii) determine if admission to an acute stroke unit when compared with patients who are not admitted to an acute stroke unit improves adherence with the FeSS protocols; iii) determine if FeSS Protocol adherence is greater for hospitals that contributed data to the FeSS optional dataset in AuSCR when compared with hospitals that did not; iv) identify what strategies or interventions have been used to implement the FeSS protocols in individual stroke services; v) identify critical individual and organisational factors, including barriers and facilitators, perceived to influence uptake and adherence of the FeSS Protocols by stroke clinicians; vi) understand barriers and facilitator variability in hospitals with high, low and variable adherence rates to FeSS Protocols, and to compare these with those previously reported in FeSS Intervention studies; vii) explore sustainability of use of FeSS Protocols for hospitals exposed to any of the FeSS Intervention studies.

Interventions

FeSS Protocol adherence in Australian hospitals since explicit recommendations for their use were included in the 2017 Australian Clinical Guidelines for Stroke Management. Observational data obtained during 20–40-minute qualitative interviews with stroke clinicians will examine the influential cultural, organisational and other factors that influence uptake of clinical guidelines, specifically, those that relate to the management of Fever, Sugar, and Swallow (FeSS) complications after stroke.

Eligibility

Sex/Gender

All

Age

18 Years to No maximum

Healthy volunteers

Yes

Inclusion criteria

1. Hospitals that participated in the 2015, 2017, 2019 and 2021 National Acute Services Stroke Audits 2. Hospitals that contributed FeSS data into AuSCR from 1/7/2019-31/12/2020. 3. All patients with a primary diagnosis of stroke (ischaemic or haemorrhagic) 4. Stroke coordinators (or equivalent) and multidisciplinary stroke clinicians with knowledge of the use of FeSS Protocols in their hospital.

Exclusion criteria

1. Those patients that have been documented for palliative care will be excluded from analysis. 2. Stroke Coordinators (or equivalent) who have been in the position six months or less will not be eligible to participate in qualitative interviews.

Outcome results