BACKGROUND In the Quality in Acute Stroke Care (QASC) trial undertaken in stroke units (SUs) located in New South Wales (NSW), Australia (2005-2010), facilitated implementation of a nurse-led care bundle to manage fever, hyperglycaemia and swallowing (FeSS protocols) reduced death and disability for patients with stroke. We aimed to determine subsequent adherence to the bundled FeSS processes (reflective of the protocols) between 2013 and 2017 in Australian hospitals, and examine whether changes in adherence to these processes varied based on previous participation in the QASC trial or subsequent statewide scale-up (QASCIP-Quality in Acute Stroke Care Implementation Project) and presence of an SU. METHODS Cross-sectional, observational study using self-reported organisational survey and retrospective clinical audit data from the National Acute Services Stroke Audit (2013, 2015, 2017). Mixed-effects logistic regression was performed with dependent variables: (1) composite outcome measure reflecting compliance with the FeSS protocols and (2) individual FeSS processes, including the year of audit as an independent variable, adjusted for correlation of outcomes within hospital. Separate models including interaction terms between the year of audit and previous participation in QASC/QASCIP and year of audit and SU were also generated. RESULTS Hospital participation included the following: 2013-124 hospitals, 3741 cases; 2015-112 hospitals, 4087 cases; and 2017-117 hospitals, 4192 cases. An 80% increase in the odds of receiving the composite outcome in 2017 compared to 2013 was found (2013, 30%; 2017, 41%; OR 1.8; 95% CI 1.6, 2.0; p < 0.001). The odds of FeSS adherence from 2013 to 2017 was greater for hospitals that had participated in QASC/QASCIP relative to those that had not (participated OR 2.1; 95% CI 1.7, 2.7; not participated OR 1.6; 95% CI 1.4, 1.8; p = 0.03). Similar uptake in adherence was evident in hospitals with and without an SU between 2013 and 2017. CONCLUSION The use of the FeSS protocols within Australia increased from 2013 to 2017 with the inclusion of these care processes in the National Audit. Greater uptake in hospitals previously involved in QASC/QASCIP was evident. Our implementation methods may be useful for other national initiatives for improving access to evidence-based practice.

中文翻译：

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急性中风国家审计中包括发烧，高血糖和吞咽管理的护理包：高档和扩散的证据。

背景技术在澳大利亚新南威尔士州（NSW）的卒中单位（SU）中进行的急性卒中护理质量（QASC）试验（2005-2010年）促进了由护士主导的护理包的实施，以控制发烧，高血糖和吞咽（FeSS方案）可减少中风患者的死亡和残疾。我们旨在确定2013年至2017年之间澳大利亚医院对捆绑的FeSS流程的后续依从性（反映方案），并根据先前参与QASC试验或随后在全州进行的规模扩大，检查对这些流程的依从性变化是否有所不同（急性中风护理实施项目的QASCIP质量）和SU的存在。方法横截面 使用自我报告的组织调查和美国国家急性服务卒中审核的回顾性临床审核数据进行的观察性研究（2013年，2015年，2017年）。使用因变量进行混合效应逻辑回归：（1）反映符合FeSS协议的合规性结果度量；（2）针对医院内结局的相关性进行调整的各个FeSS流程（包括作为独立变量的审计年份）。还生成了单独的模型，包括审计年份和以前参与QASC / QASCIP以及审计年份和SU之间的交互条件。结果医院的参与情况包括：2013-124医院，3741例；2015-112医院，4087例; 和2017-117所医院中，有4192例。与2013年相比，2017年获得综合结果的几率增加了80％（2013，30％; 2017，41％; OR 1.8; 95％CI 1.6，2.0; p <0.001）。参加QASC / QASCIP的医院从2013年到2017年接受FeSS的几率比未参加（参加OR 2.1; 95％CI 1.7，2.7;未参加OR 1.6; 95％CI 1.4，1.8; p = 0.03）。在2013年至2017年之间，无论有无SU的医院，依从性均得到类似的吸收。结论结论2013年至2017年，澳大利亚将FeSS方案的使用量增加，并将这些护理程序纳入了国家审计。很明显，以前参与QASC / QASCIP的医院的吸收率更高。我们的实施方法可能对其他国家举措有所帮助，以改善获取循证实践的机会。