Nurse-initiated acute stroke care in emergency departments : The triage, treatment, and transfer implementation cluster randomized controlled trial
| Autor: | Clare Quinn, Mark Longworth, Jeremy M. Grimshaw, Sonia Denisenko, Dominique A Cadilhac, Patrick McElduff, Mark Fitzgerald, Catherine D'Este, Christopher Levi, Simeon Dale, Greg Cadigan, Julie Considine, Louise E. Craig, Sandy Middleton, N. Wah Cheung, Elizabeth McInnes, Richard P. Gerraty, Verena Schadewaldt, Jeanette E Ward |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
dysphagia law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Modified Rankin Scale law medicine 030212 general & internal medicine Stroke Site Visit nurse-led Advanced and Specialized Nursing fever implementation science business.industry Emergency department medicine.disease Triage Dysphagia stroke Clinical trial Emergency medicine care bundle Neurology (clinical) hyperglycemia medicine.symptom Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery |
| Popis: | Background and Purpose— We aimed to evaluate the effectiveness of an intervention to improve triage, treatment, and transfer for patients with acute stroke admitted to the emergency department (ED). Methods— A pragmatic, blinded, multicenter, parallel group, cluster randomized controlled trial was conducted between July 2013 and September 2016 in 26 Australian EDs with stroke units and tPA (tissue-type plasminogen activator) protocols. Hospitals, stratified by state and tPA volume, were randomized 1:1 to intervention or usual care by an independent statistician. Eligible ED patients had acute stroke 3 intervention targeted (1) Triage to Australasian Triage Scale category 1 or 2; (2) Treatment: tPA eligibility screening and appropriate administration; clinical protocols for managing fever, hyperglycemia, and swallowing; (3) prompt ( Results— Twenty-six EDs (13 intervention and 13 control) recruited 2242 patients (645 preintervention and 1597 postintervention). There were no statistically significant differences at follow-up for 90-day modified Rankin Scale (intervention: n=400 [53.5%]; control n=266 [48.7%]; P =0.24) or secondary outcomes. Conclusions— This evidence-based, theory-informed implementation trial, previously effective in stroke units, did not change patient outcomes or clinician behavior in the complex ED environment. Implementation trials are warranted to evaluate alternative approaches for improving ED stroke care. Clinical Trial Registration— URL: http://www.anzctr.org.au . Unique identifier: ACTRN12614000939695. |
| Databáze: | OpenAIRE |
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