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Title: Triage, treatment and transfer of patients with stroke in emergency department trial (the T3 trial): a cluster randomised trial protocol.
Epworth Authors: Gerraty, Richard
Other Authors: Middleton, Sandy
Levi, Chris
Dale, Simeon
Cheung, N. Wah
McInnes, Elizabeth
Considine, Julie
D'Este, Catherine
Cadilhac, Dominique
Grimshaw, Jeremy
Craig, Louise
Schwadewaldt, Verena
McElduff, Patrick
Fitzgerald, Mark
Quinn, Clare
Cadigan, Greg
Denisenko, Sonia
Longworth, Mark
Ward, Jeanette
May, C.
Grimley, R.
Paolini, R.
Phillips, R.
Salema, E.
Pitkin, J.
Sheridan, T.
Keywords: Critical Care Clinical Institute, Epworth HealthCare, Victoria, Australia
Neurosciences Clinical Institute, Epworth HealthCare, Victoria, Australia
Patient Care Bundles
Deglutition Disorders
CVA (Cerebrovascular Accident)
Emergency Service, Hospital
Hospital Emergency Service
Emergency Responders
Tissue Plasminogen Activator
Patient Transfer
Modified Rankin Scale
Australian Triage Scale
Barthel Index
Issue Date: Oct-2016
Publisher: Springer
Citation: Implementation Science 2016 Oct 18;11(1):139
Abstract: BACKGROUND: Internationally recognised evidence-based guidelines recommend appropriate triage of patients with stroke in emergency departments (EDs), administration of tissue plasminogen activator (tPA), and proactive management of fever, hyperglycaemia and swallowing before prompt transfer to a stroke unit to maximise outcomes. We aim to evaluate the effectiveness in EDs of a theory-informed, nurse-initiated, intervention to improve multidisciplinary triage, treatment and transfer (T3) of patients with acute stroke to improve 90-day death and dependency. Organisational and contextual factors associated with intervention uptake also will be evaluated. METHODS: This prospective, multicentre, parallel group, cluster randomised trial with blinded outcome assessment will be conducted in EDs of hospitals with stroke units in three Australian states and one territory. EDs will be randomised 1:1 within strata defined by state and tPA volume to receive either the T3 intervention or no additional support (control EDs). Our T3 intervention comprises an evidence-based care bundle targeting: (1) triage: routine assignment of patients with suspected stroke to Australian Triage Scale category 1 or 2; (2) treatment: screening for tPA eligibility and administration of tPA where applicable; instigation of protocols for management of fever, hyperglycaemia and swallowing; and (3) transfer: prompt admission to the stroke unit. We will use implementation science behaviour change methods informed by the Theoretical Domains Framework consisting of (i) workshops to determine barriers and local solutions; (ii) mixed interactive and didactic education; (iii) local clinical opinion leaders; and (iv) reminders in the form of email, telephone and site visits. Our primary outcome measure is 90 days post-admission death or dependency (modified Rankin Scale >2). Secondary outcomes are health status (SF-36), functional dependency (Barthel Index), quality of life (EQ-5D); and quality of care outcomes, namely, monitoring and management practices for thrombolysis, fever, hyperglycaemia, swallowing and prompt transfer. Outcomes will be assessed at the patient level. A separate process evaluation will examine contextual factors to successful intervention uptake. At the time of publication, EDs have been randomised and the intervention is being implemented. DISCUSSION: This theoretically informed intervention is aimed at addressing important gaps in care to maximise 90-day health outcomes for patients with stroke.
DOI: 10.1186/s13012-016-0503-6
PubMed URL:
ISSN: 1748-5908
Journal Title: Implementation Science
Type: Journal Article
Affiliated Organisations: Nursing Research Institute, St Vincent's Health Australia
John Hunter Hospital, Newcastle, Australia.
Centre for Translational Neuroscience and Mental Health, University of Newcastle/Hunter Medical Research Institute, Newcastle, New South Wales, Australia
Centre for Diabetes and Endocrinology Research, Westmead Hospital and University of Sydney, Westmead, Sydney, New South Wales, Australia
Faculty of Health, Eastern Health - Deakin University Nursing and Midwifery Research Centre School of Nursing and Midwifery, Burwood, Victoria, Australia.
National Centre for Epidemiology and Population Health (NCEPH), Australian National University, Canberra, Australian Capital Territory, Australia.
Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Victoria, Australia.
Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia.
Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada.
Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Department of Medicine, Monash University, Melbourne, Victoria, Australia.
School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
Alfred Hospital, Melbourne, Victoria, Australia.
Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
Faculty of Science, Engineering and Technology, Swinburne University of Technology, Melbourne, Victoria, Australia.
Speech Pathology Department, Prince of Wales Hospital, Randwick, New South Wales, Australia.
Statewide Stroke Clinical Network, Brisbane, Queensland, Australia.
Department of Health Victoria, Victorian Stroke Clinical Network, Melbourne, Victoria, Australia.
Stroke Services NSW, NSW Agency for Clinical Innovation, Chatswood, New South Wales, Australia.
School of Epidemiology, Public Health and Preventive Medicine (SEPHPM), University of Ottawa, Ottawa, Ontario, Canada.
Nulungu Research Institute, University of Notre Dame Australia, Broome, Western Australia, Australia.
Australian Catholic University, St Vincent's Hospital, Darlinghurst, New South Wales, Australia.
Type of Clinical Study or Trial: Randomized Clinical Trial
Appears in Collections:Emergency Care

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