Stroke, TIA
Conditions
Brief summary
The aim of the study is to monitor if specialized stroke nurses as team partners in the ED can reduce hospital acquired infections. The study is designed as pre- post-intervention study in which specialized SU nurses partner with ED nursing staff to asses and screen stroke admissions in the ED.
Detailed description
An intervention study comprised of 1) a primary registry database component and 2) a secondary questionnaire based quantitative evaluation . The intervention study includes a 3-month baseline observational period followed by a 7-month baseline data collection period, a 2-month intervention implementation phase, and a 3-month intervention observational period followed by 7-month intervention data collection period. An intervention, where dedicated stroke nurses handle acute care of stroke and TIA patient in the ED prior to admission to a dedicated stroke unit will take place in the timeframe of 11-19:00 hrs, 7 days a week. Notably, the intervention is set to be integrated into clinical practice on a permanent basis after end of study. Data for all stroke patients admitted to the ED at HGH are collected during the 3-month baseline and intervention observational periods. Fulfilment of Danish Stroke Quality Program (DAP) quality indicators is monitored as follows - use of dysphagia screen (GUSS), mobilization within day of ED admission and transfer to SU. Additional nursing interventions monitored in the ED are: Use of nasogastric catheter, use of bladder scan and intermittent catheterization, frequency of temperature monitoring and use of anti-pyretics, acute phase monitoring of blood-pressure every 2 hours, use of Scandinavian Stroke Scale (SSS) score. Outcomes are monitored in hospital and at visits to the out patient clinic, as well as by registry.
Interventions
BEHAVIORALDedicated stroke nurse care in ED
A specialized SU nursing team partner with ED nursing staff for timely fulfillment of stroke quality care indicators while awationg admission to a dedicated stroke unit
Sponsors
University of Copenhagen
Herlev Hospital
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* patients referred to the ED at Herlev Hospital with a diagnosis of stroke or TIA from 11 Am to 7 PM * patients fulfilling one of the following ICD-10 codes at discharge: ICH: I61, cerebral infarction; I63, unspecified: I64, TIA: G45 and a scheduled follow-up appointment at the outpatient clinic Herlev Hospital
Exclusion criteria
* Patients transferred from other hospitals or stroke units * Patients elegible for thrombolysis or thrombectomy at time of admission
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of infections | 7 days from admission | Incidence of pneumonia and urinary tract infections defined by a combination of clinical symptoms and para-clinical tests. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rate of re-admission within 30 days | 30 days from first admission | Number of re-admission for any disease post stroke |
| Number of patients with post stroke depression | baseline and 90 days and 1 year after admission | new onset depression and antidepressant prescriptions within 90 days and 1 year from stroke |
| Level of 90-day post-stroke dependency | baseline and 90 days from admission | via modified Rankin Scale (mRS) score (0-6, 0=best) |
| 30-day mortality or recurrent cerebrovascular event | 30 days from first admission | Composite measure of mortality, cerebrovascular or cardiovascular incidence |
| Length of stay | 90 days from admission | Total time of hospital admission |
| Dependency | Within 90 days from admission | Barthel Index |
| Mental health | within 90 days from admission | WHO-Five Well-Being index |
Countries
Denmark
Outcome results
None listed