Learning Objective 1: - understand the value of incorporating proven implementation strategies when introducing new treatment protocols
Learning Objective 2: - identify successful strategies to change clinician behaviour and improve patient outcomes
Methods: 19 Australian acute stroke units (ASUs) were randomised to the intervention (n=10) or control group (n=9). Intervention ASUs received evidence-based protocols for fever, hyperglycaemia and swallowing management with multidisciplinary team building workshops, an education program and engagement of local champions. Control ASUs received only an abridged copy of the Australian stroke guidelines. Two patient cohorts (one pre and one post-intervention) were recruited. Medical records were prospectively audited by independent blinded research assistants. Intention to treat analysis was used adjusting for baseline data and clustering.
Results: Data from 1699 patients demonstrated that those from intervention ASU’s were significantly less likely to be dead or dependent at 90-days than patients from control stroke units (p=0.002); with improved SF-36 mean physical health scores (p=0.002); reductions in mean temperature (p=0·001), mean glucose (p=0·02); and improved swallow screening (p<0·001). Patients from intervention ASUs also were significantly more likely than those from control ASUs to have had all the relevant protocol monitoring and treatment elements for fever (p<0.001), glucose (p<0.001) and swallowing (p<0.001).
Conclusion: This landmark trial demonstrates the value of doing the simple things well. It is one of the few studies to show that teamwork and good bedside nursing care can influence morbidity and mortality and improve evidence uptake. This highly effective implementation strategy was simple and easily reproducible in any nursing setting. Rigorous evaluation in alternative nursing settings is warranted.
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