Publications by authors named "Kelly Coughlan"
Background: The Quality in Acute Stroke Care (QASC) Trial demonstrated that assistance to implement protocols to manage Fever, hyperglycaemia (Sugar) and Swallowing (FeSS) post-stroke reduced death and disability. In 2017, a 'Strong Recommendation' for use of FeSS Protocols was included in the Australian Clinical Guidelines for Stroke Management. We aimed to: i) compare adherence to FeSS Protocols pre- and post-guideline inclusion; ii) determine if adherence varied with prior participation in a treatment arm of a FeSS Intervention study, or receiving treatment in a stroke unit; and compare findings with our previous studies.
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- - The study evaluated the impact of nurse-led implementation of protocols to manage fever, hyperglycemia, and swallowing in German stroke units, showing significant improvements in adherence to these protocols after training and support from an Australian team.
- - Results indicated a notable increase in overall adherence from 20% to 28%, with specific improvements in managing hyperglycemia (from 43% to 55%) and swallowing (from 52% to 61%), though fever protocol adherence showed little change.
- - Additional findings revealed increased timely administration of anti-pyretics and insulin, as well as improved screening for swallowing within 24 hours of admission, highlighting the effectiveness of the implemented support strategies.
Article Synopsis
- The QASC Australia trial showed that nurse-led protocols for managing fever, sugar levels, and swallowing (FeSS Protocols) can reduce deaths and disabilities after a stroke, prompting a larger study in Europe involving 64 hospitals across 17 countries to evaluate the scalability of these protocols.
- The implementation process was supported by a multi-stakeholder framework that included academic partners and the Angels Initiative, a non-profit organization focused on promoting evidence-based stroke care.
- A qualitative evaluation was conducted through interviews with various stakeholders to identify factors affecting the engagement and implementation of the FeSS Protocols, revealing three main themes regarding the challenges and facilitators of this process.
BACKGROUND: Stroke unit care reduces patient morbidity and mortality. The Quality in Acute Stroke Care Europe Study achieved significant large-scale translation of nurse-initiated protocols to manage Fever, hyperglycemia (Sugar), and Swallowing (FeSS) in 64 hospitals across 17 European countries. However, not all hospitals had stroke units.
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- The Registry of Stroke Care Quality (RES-Q) is an international platform that helps standardize the evaluation of stroke care quality and performance in hospitals.
- A survey conducted between October 2021 and February 2022 reached out to local coordinators from 1463 hospitals globally, with 358 responses, revealing that RES-Q data is frequently utilized to enhance stroke care quality, track improvements, and benchmark practices.
- A significant number of respondents expressed the need for formal training and education on using RES-Q data effectively, indicating that understanding quality improvement methods could lead to better clinical practices and outcomes in stroke care.
Article Synopsis
- - Poor adherence to stroke care guidelines is a global issue, but the QASC trial showed that nurse-led implementation can significantly improve patient outcomes like death and disability.
- - A multi-country study from 2017 to 2021 assessed the effectiveness of the FeSS Protocol across 64 hospitals, revealing substantial improvements in the care elements related to fever, hyperglycemia, and swallowing.
- - The successful rollout of the FeSS Protocol across diverse healthcare systems demonstrated that both high-income and middle-income countries could achieve similar enhancements in stroke care practices.
Background And Purpose: Implementation of nurse-initiated protocols to manage fever, hyperglycemia, and swallowing dysfunction decreased death and disability 90 days poststroke in the QASC trial (Quality in Acute Stroke Care) conducted in 19 Australian acute stroke units (2005-2010). We now examine long-term all-cause mortality.
Methods: Mortality was ascertained using Australia's National Death Index.
Article Synopsis
- * In a survey conducted with 41 acute stroke units, less than 50% had a formal urinary incontinence management plan, and most respondents without a plan expressed the need for one.
- * The findings highlighted a significant gap in effective urinary incontinence management, emphasizing the need for additional training and resources for healthcare professionals to enhance patient care post-stroke.
Article Synopsis
- - The study evaluates the use of the Melbourne Ambulance Stroke Screen (MASS) by paramedics in Australia, highlighting its effectiveness for diagnosing strokes compared to other methods, particularly the Cincinnati Prehospital Stroke Scale, which has been found to be less effective.
- - Data from 2008 shows that MASS was used in 16% of emergency transports, and the sensitivity and specificity of paramedic diagnoses were generally high, with paramedic diagnosis being more sensitive than the MASS and similar to the Cincinnati Prehospital Stroke Scale.
- - Overall, the findings indicate that paramedics have successfully integrated MASS into their assessment process for strokes, maintaining a high level of diagnostic performance since its implementation in 2005.
Article Synopsis
- Recent evidence indicates a significant short-term risk of ischemic stroke following a transient ischemic attack (TIA), and the "ABCD Score" can help identify high-risk patients based on specific health metrics.
- A retrospective study evaluated 98 TIA patients in an emergency department using the ABCD Score to predict strokes at 7 and 90 days, finding that 49% were classified as high risk.
- The results showed that the ABCD Score effectively predicted stroke risk, achieving high sensitivity and negative predictive value, though it was overinclusive; removing the age factor reduced false-positive results without losing predictive accuracy.