Study protocol

Fever, hyperglycaemia and swallowing dysfunction management in acute stroke: A cluster randomised controlled trial of knowledge transfer

Sandy Middleton¹ , Christopher Levi² , Jeanette Ward³ , Jeremy Grimshaw⁴ , Rhonda Griffiths⁵ , Catherine D'Este⁶ , Simeon Dale⁷ , N Wah Cheung⁸ , Clare Quinn⁹ , Malcolm Evans¹⁰ and Dominique Cadilhac¹¹

¹  St Vincents and Mater Health Sydney, Victoria St, Darlinghurst, 2010, NSW, Australia

²  Hunter Stroke Service, Neurology Unit, John Hunter Hospital and Hunter Medical Research Institute, Lookout Rd, New Lambton Heights NSW 2305, Australia

³  Department of Epidemiology and Community Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5, Canada

⁴  Canada Research Chair in Health Knowledge, Transfer and Uptake, Director, Clinical Epidemiology Program, Ottawa Health Research Institute, 1053 Carling Avenue, Administration Building, Room 2-017, Ottawa, Ontario K1Y 4E9, Canada

⁵  School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith South DC NSW 1797, Australia

⁶  Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, Newcastle NSW 2300, Australia

⁷  National Centre for Clinical Outcomes Research (NaCCOR), Nursing and Midwifery, ACU National, PO Box 968, North Sydney, NSW 2059, Australia

⁸  Department of Diabetes and Endocrinology, Westmead Hospital and University of Sydney, PO Box 533, Wentworthville NSW 2145, Australia

⁹  Prince of Wales Hospital, High St, Randwick NSW 2031, Australia

¹⁰  Acute Stroke Research, John Hunter Hospital and Hunter Medical Research Institute, Lookout Rd, New Lambton Heights NSW 2305, Australia

¹¹  Public Health Division, National Stroke Research Institute, Level 1, Neurosciences Building, Heidelberg Repatriation Hospital, Gate 10, 300 Waterdale Rd., Heidelberg Heights, Victoria 3081, Australia

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Implementation Science 2009, 4:16doi:10.1186/1748-5908-4-16

Published:	16 March 2009

Abstract

Background

Hyperglycaemia, fever, and swallowing dysfunction are poorly managed in the admission phase of acute stroke, and patient outcomes are compromised. Use of evidence-based guidelines could improve care but have not been effectively implemented. Our study aims to develop and trial an intervention based on multidisciplinary team-building to improve management of fever, hyperglycaemia, and swallowing dysfunction in patients following acute stroke.

Methods and design

Metropolitan acute stroke units (ASUs) located in New South Wales, Australia will be stratified by service category (A or B) and, within strata, by baseline patient recruitment numbers (high or low) in this prospective, multicentre, single-blind, cluster randomised controlled trial (CRCT). ASUs then will be randomised independently to either intervention or control groups. ASUs allocated to the intervention group will receive: unit-based workshops to identify local barriers and enablers; a standardised core education program; evidence-based clinical treatment protocols; and ongoing engagement of local staff. Control group ASUs will receive only an abridged version of the National Clinical Guidelines for Acute Stroke Management. The following outcome measures will be collected at 90 days post-hospital admission: patient death, disability (modified Rankin Score); dependency (Barthel Index) and Health Status (SF-36). Additional measures include: performance of swallowing screening within 24 hours of admission; glycaemic control and temperature control.

Discussion

This is a unique study of research transfer in acute stroke. Providing optimal inpatient care during the admission phase is essential if we are to combat the rising incidence of debilitating stroke. Our CRCT will also allow us to test interventions focussed on multidisciplinary ASU teams rather than individual disciplines, an imperative of modern hospital services.

Trial Registration

Australia New Zealand Clinical Trial Registry (ANZCTR) No: ACTRN12608000563369