Improving stroke Emergency Department nursing care: The Code Stroke 2.0 pre-test/post-test feasibility study

IF 1.6 4区医学 Q2 NURSING

Collegian Pub Date : 2023-10-01 DOI:10.1016/j.colegn.2023.04.002

Brett Jones , Oyebola Fasugba , Simeon Dale , Chris Burrows , Manju John , Mary Doncillo , Simogne Wright , Christian Lueck , Catherine D’Este , Ben McElduff , Elizabeth McInnes , Sandy Middleton

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引用次数: 0

Abstract

Background

Activation of an acute ‘Code Stroke’ pathway on hospital arrival improves thrombolysis rates. Whilst post-stroke protocols to manage fever, hyperglycaemia, and dysphagia (Fever, Sugar and Swallow (FeSS) Protocols) have been shown to reduce death and dependency, facilitated implementation in Emergency Department (ED) has been difficult.

Aim

To evaluate if an expanded role for an Acute Stroke Nurse improves Code Stroke activation, increases FeSS Protocol uptake in ED, and results in faster stroke unit transfer.

Methods

A pre-test/post-test feasibility study undertaken in an Australian ED. Intervention comprised an expanded Acute Stroke Nurse role who instigated FeSS Protocol care or supported ED clinicians to use the protocols. Logistic regression analyses compared outcomes pre-test/post-test intervention. Subgroup analysis examined intervention effect during business hours.

Findings

There were 117 patients each in the pre-intervention and post-intervention cohorts (n = 234). Post-intervention patients had significantly more Code Stroke activations (pre: 7%, post: 62%), temperature at ED arrival (pre: 62%, post: 78%), formal blood glucose (pre: 55%, post: 98%), fewer oral medications administered before swallow screening (pre: 31%, post: 14%), more stroke unit transfers within 4 h from ED arrival (pre: 26%, post: 41%), and thrombolysis screening (pre: 53%, post: 80%). Subgroup analysis during business hours showed significant improvement in Code Stroke activations (pre: 10%, post: 79%), formal blood glucose testing (pre: 57%, post: 98%), reduced oral medications before swallow screening (pre: 24%, post: 9%), and thrombolysis screening (pre: 45%, post: 82%).

Conclusion

Expanding the Acute Stroke Nurse role to support ED staff during Code Stroke was associated with improved stroke care processes. Our findings highlight potential for successful implementation of this model across multiple hospitals to improve patient outcomes.

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改进脑卒中急诊科护理:脑卒中代码2.0前测/后测可行性研究

背景:在到达医院时激活急性“码脑卒中”通路可提高溶栓率。虽然中风后处理发烧、高血糖和吞咽困难的方案(发烧、糖和吞咽(FeSS)方案)已被证明可以减少死亡和依赖性，但在急诊科(ED)实施起来很困难。目的评估扩大急性卒中护士的角色是否能改善编码卒中激活，增加ED患者对FeSS方案的吸收，并导致更快的卒中单位转移。方法在澳大利亚急诊科进行了一项测试前/测试后可行性研究。干预包括扩大急性卒中护士的角色，他们鼓励FeSS方案护理或支持急诊科临床医生使用该方案。Logistic回归分析比较了测试前/测试后干预的结果。亚组分析检查了营业时间的干预效果。结果干预前和干预后各有117例患者(n = 234)。干预后患者有更多的代码卒中激活(前:7%，后:62%)，ED到达时的体温(前:62%，后:78%)，正式血糖(前:55%，后:98%)，吞咽筛查前口服药物减少(前:31%，后:14%)，ED到达后4小时内卒中单位转移(前:26%，后:41%)和溶栓筛查(前:53%，后:80%)。营业时间的亚组分析显示，码脑卒中激活(前:10%，后:79%)、正式血糖检测(前:57%，后:98%)、吞咽筛查前口服药物减少(前:24%，后:9%)和溶栓筛查(前:45%，后:82%)均有显著改善。结论扩大急性卒中护士的角色，以支持急诊科工作人员在急性卒中期间改善卒中护理过程。我们的研究结果强调了在多家医院成功实施这种模式以改善患者预后的潜力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Collegian NURSING-

CiteScore

2.70

自引率

6.70%

发文量

127

审稿时长

72 days

期刊介绍： Collegian: The Australian Journal of Nursing Practice, Scholarship and Research is the official journal of Australian College of Nursing (ACN). The journal aims to reflect the broad interests of nurses and the nursing profession, and to challenge nurses on emerging areas of interest. It publishes research articles and scholarly discussion of nursing practice, policy and professional issues. Papers published in the journal are peer reviewed by a double blind process using reviewers who meet high standards of academic and clinical expertise. Invited papers that contribute to nursing knowledge and debate are published at the discretion of the Editor. The journal, online only from 2016, is available to members of ACN and also by separate subscription. ACN believes that each and every nurse in Australia should have the opportunity to grow their career through quality education, and further our profession through representation. ACN is the voice of influence, providing the nursing expertise and experience required when government and key stakeholders are deciding the future of health.