{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T03:04:26Z","timestamp":1785294266931,"version":"3.55.0"},"reference-count":40,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2016,3,4]]},"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      To embed an evidence-based intervention to manage\n                      <jats:italic>FE<\/jats:italic>\n                      ver, hyperglycaemia (\n                      <jats:italic>S<\/jats:italic>\n                      ugar) and\n                      <jats:italic>S<\/jats:italic>\n                      wallowing (the FeSS protocols) in stroke, previously demonstrated in the Quality in Acute Stroke Care (QASC) trial to decrease 90-day death and dependency, into all stroke services in New South Wales (NSW), Australia's most populous state.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Pre-test\/post-test prospective study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>36 NSW stroke services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Our clinical translational initiative, the QASC Implementation Project (QASCIP), targeted stroke services to embed 3 nurse-led clinical protocols (the FeSS protocols) into routine practice. Clinical champions attended a 1-day multidisciplinary training workshop and received standardised educational resources and ongoing support. Using the National Stroke Foundation audit collection tool and processes, patient data from retrospective medical record self-reported audits for 40 consecutive patients with stroke per site pre-QASCIP (1 July 2012 to 31 December 2012) were compared with prospective self-reported data from 40 consecutive patients with stroke per site post-QASCIP (1 November 2013 to 28 February 2014). Inter-rater reliability was substantial for 10 of 12 variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measures<\/jats:title>\n                    <jats:p>Proportion of patients receiving care according to the FeSS protocols pre-QASCIP to post-QASCIP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All 36 (100%) NSW stroke services participated, nominating 100 site champions who attended our educational workshops. The time from start of intervention to completion of post-QASCIP data collection was 8\u2005months. All (n=36, 100%) sites provided medical record audit data for 2144 patients (n=1062 pre-QASCIP; n=1082 post-QASCIP). Pre-QASCIP to post-QASCIP, proportions of patients receiving the 3 targeted clinical behaviours increased significantly: management of fever (pre: 69%; post: 78%; p=0.003), hyperglycaemia (pre: 23%; post: 34%; p=0.0085) and swallowing (pre: 42%; post: 51%; p=0.033).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We obtained unprecedented statewide scale-up and spread to all NSW stroke services of a nurse-led intervention previously proven to improve long-term patient outcomes. As clinical leaders search for strategies to improve quality of care, our initiative is replicable and feasible in other acute care settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2016-011568","type":"journal-article","created":{"date-parts":[[2016,5,7]],"date-time":"2016-05-07T05:40:36Z","timestamp":1462599636000},"page":"e011568","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["From QASC to QASCIP: successful Australian translational scale-up and spread of a proven intervention in acute stroke using a prospective pre-test\/post-test study design"],"prefix":"10.1136","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7201-4394","authenticated-orcid":false,"given":"Sandy","family":"Middleton","sequence":"first","affiliation":[{"name":"Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Lydtin","sequence":"additional","affiliation":[{"name":"Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Comerford","sequence":"additional","affiliation":[{"name":"NSW Agency for Clinical Innovation, Chatswood, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique A","family":"Cadilhac","sequence":"additional","affiliation":[{"name":"Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia"},{"name":"School of Clinical Sciences, Monash University, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"McElduff","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simeon","family":"Dale","sequence":"additional","affiliation":[{"name":"Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelvin","family":"Hill","sequence":"additional","affiliation":[{"name":"National Stroke Foundation, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Longworth","sequence":"additional","affiliation":[{"name":"Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanette","family":"Ward","sequence":"additional","affiliation":[{"name":"University of Notre Dame, Broom Campus, Broome, Western Australia, Australia"},{"name":"University of Ottawa, Ottawa, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N Wah","family":"Cheung","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia"},{"name":"University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cate","family":"D'Este","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology and Population Health (NCEPH), Australian National University, Canberra, Australian Capital Territory, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2016,5,6]]},"reference":[{"key":"2025121403473979000_6.5.e011568.1","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-7-1"},{"key":"2025121403473979000_6.5.e011568.2","doi-asserted-by":"crossref","unstructured":"Balas E , Boren S . Managing Clinical Knowledge for Health Care Improvement. In: van Bemmel JH , McCray AT , eds. Yearbook of Medical Informatics. Stuttgart: Schattauer Verlagsgesellschaft mbH, 2000:65\u201370.","DOI":"10.1055\/s-0038-1637943"},{"key":"2025121403473979000_6.5.e011568.3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.317.7156.465"},{"key":"2025121403473979000_6.5.e011568.4","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-200108002-00002"},{"key":"2025121403473979000_6.5.e011568.5","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.006139"},{"key":"2025121403473979000_6.5.e011568.6","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1186\/1745-6215-15-509","article-title":"Identifying continence options after stroke (ICONS): a cluster randomised controlled feasibility trial","volume":"15","author":"Thomas","year":"2014","journal-title":"Trials"},{"key":"2025121403473979000_6.5.e011568.7","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-5-14"},{"key":"2025121403473979000_6.5.e011568.8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-0009.2011.00625.x"},{"key":"2025121403473979000_6.5.e011568.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2004.09.002"},{"key":"2025121403473979000_6.5.e011568.10","doi-asserted-by":"publisher","DOI":"10.1093\/heapro\/dar097"},{"key":"2025121403473979000_6.5.e011568.11","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(12)70168-8"},{"key":"2025121403473979000_6.5.e011568.12","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/S1473-3099(13)70050-1","article-title":"2018 must be the final target for polio eradication","volume":"13","author":"The Lancet Infectious Diseases","year":"2013","journal-title":"Lancet Infect Dis"},{"key":"2025121403473979000_6.5.e011568.13","doi-asserted-by":"publisher","DOI":"10.1186\/1478-4505-12-18"},{"key":"2025121403473979000_6.5.e011568.14","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa061115"},{"key":"2025121403473979000_6.5.e011568.15","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d219"},{"key":"2025121403473979000_6.5.e011568.16","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-8-70"},{"key":"2025121403473979000_6.5.e011568.17","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61485-2"},{"key":"2025121403473979000_6.5.e011568.18","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(13)70130-3"},{"key":"2025121403473979000_6.5.e011568.19","first-page":"CD000197","article-title":"Organised inpatient (stroke unit) care for stroke","volume":"9","author":"Stroke Unit Trialists\u2019 Collaboration","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121403473979000_6.5.e011568.20","unstructured":"Grol R , Wensing M , Eccles M . Implementation of changes in practice. Improving patient care. The implementation of change in clinical practice. Edinburgh: Elsevier, 2005:6\u201315."},{"key":"2025121403473979000_6.5.e011568.21","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-2-21"},{"key":"2025121403473979000_6.5.e011568.22","first-page":"503","article-title":"Evidence-based implementation of evidence-based medicine","volume":"25","author":"Grol","year":"1999","journal-title":"Jt Comm J Qual Improv"},{"key":"2025121403473979000_6.5.e011568.23","doi-asserted-by":"crossref","unstructured":"Flodgren G , Parmelli E , Doumit G , et al . Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2011;(8):CD000125. doi:10.1002\/14651858.CD000125.pub4","DOI":"10.1002\/14651858.CD000125.pub4"},{"key":"2025121403473979000_6.5.e011568.24","doi-asserted-by":"publisher","DOI":"10.1111\/ijs.12202"},{"key":"2025121403473979000_6.5.e011568.25","doi-asserted-by":"publisher","DOI":"10.1136\/qshc.2008.029058"},{"key":"2025121403473979000_6.5.e011568.26","unstructured":"National Stroke Foundation. Acute stroke services framework. Melbourne, Victoria: NSF, 2010."},{"key":"2025121403473979000_6.5.e011568.27","unstructured":"Australian Diabetes Society. Guidelines for routine glucose control in hospital. Australia: Australian Diabetes Society, 2012."},{"key":"2025121403473979000_6.5.e011568.28","unstructured":"National Stroke Foundation. National stroke audit\u2014acute services clinical audit report. Melbourne, Australia, 2013."},{"key":"2025121403473979000_6.5.e011568.29","unstructured":"National Stroke Foundation. National stroke audit acute services\u2014organisational survey. National Stroke Foundation, 2013."},{"key":"2025121403473979000_6.5.e011568.30","unstructured":"National Stroke Foundation. Acute audit. https:\/\/strokefoundation.com.au\/what-we-do\/treatment-programs\/stroke-data-collection\/acute-audit (accessed Jun 2015)."},{"key":"2025121403473979000_6.5.e011568.31","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzt037"},{"key":"2025121403473979000_6.5.e011568.32","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"issue":"2","key":"2025121403473979000_6.5.e011568.33","doi-asserted-by":"crossref","first-page":"S58","DOI":"10.1007\/s11606-006-0276-8","article-title":"Strategies for promoting organizational and practice change by advancing implementation research","volume":"21","author":"Rubenstein","year":"2006","journal-title":"J Gen Intern Med"},{"key":"2025121403473979000_6.5.e011568.34","doi-asserted-by":"publisher","DOI":"10.1111\/ijs.12374_5"},{"key":"2025121403473979000_6.5.e011568.35","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.001258"},{"key":"2025121403473979000_6.5.e011568.36","unstructured":"Australian Institute of Health and Welfare. Rural, regional and remote health: indicators of health system performance. Cat. no. PHE 103. Canberra: AIHW, 2008."},{"key":"2025121403473979000_6.5.e011568.37","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.594374"},{"key":"2025121403473979000_6.5.e011568.38","first-page":"468","article-title":"Improving the quality of quality improvement projects","volume":"36","author":"Berenholtz","year":"2010","journal-title":"Jt Comm J Qual Patient Saf"},{"key":"2025121403473979000_6.5.e011568.39","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdu027"},{"key":"2025121403473979000_6.5.e011568.40","first-page":"166","article-title":"Stroke care in Australia: Why is it still the poor cousin of health care?","volume-title":"Med J Aust","volume":"199","author":"Middleton","year":"2013"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2016-011568","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T11:47:50Z","timestamp":1765712870000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2016-011568"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,5]]},"references-count":40,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2016,5,6]]},"published-print":{"date-parts":[[2016,5]]}},"alternative-id":["10.1136\/bmjopen-2016-011568"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2016-011568","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,5]]}}}