Oral Presentation Smart Strokes Annual Scientific Meeting 2025

FeSS Up or Fall Short? Protocols in Everyday Practice vs Trials Data (127115)

Simeon Dale 1 2 , Oyebola Fasugba 1 2 , Kelly Coughlan 1 2 , Elizabeth Mcinnes 1 2 , Dominique A Cadilhac 3 4 , N Wah Cheung 5 , Kelvin Hill 6 , Kirsty Page 7 , Estela Sanjuan 8 , Emily Neal 9 , Vivien Pollnow 10 , Eileen Gilder 11 , Julia Slark 11 , Anna Ranta 12 , Christopher Levi 13 14 , Jeremy Grimshaw 15 16 , Sandy Middleton 1 2
  1. St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Darlinghurst, NSW, Australia
  2. School of Nursing, Midwifery and Paramedicine, Australian Catholic University & St Vincents Health (Sydney), Darlinghurst, NSW, Australia
  3. Stroke theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
  4. Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
  5. Centre for Diabetes and Endocrinology Research, Westmead Hospital and University of Sydney, Westmead, NSW, Australia
  6. Stroke Foundation, Sydney, NSW, Australia
  7. Stroke Unit, St Vincent’s Health Network Sydney, Darlinghurst, NSW, Australia
  8. Vall d’Hebron Hospital, Universitari Barcelona, Barcelona, Spain
  9. Speech Pathology Department, John Hunter Hospital, Lambton Heights, NSW, Australia
  10. St Vincent's Health Network Sydney, Darlinghurst, NSW, Australia
  11. School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
  12. Department of Medicine, University of Otago , Wellington, New Zealand
  13. John Hunter Hospital, Lambton Heights, NSW, Australia
  14. Department of Medicine, University of Newcastle, Newcastle, NSW, Australia
  15. Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  16. Methodological and Implementation Research Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

Introduction: The Quality in Acute Stroke Care (QASC) Research Program utilises implementation strategies to empower clinicians to use protocols for managing fever, hyperglycaemia (sugar) and swallowing (FeSS). Persistent gaps remain in FeSS Protocol adherence based on data from the National Acute Stroke Audits (2013-2023). The QASC Australasia Trial is evaluating the required dose of facilitation to improve implementation. We analysed baseline trial data (2022–2025) from 45 hospitals and audit data (2023) from 107 hospitals to compare protocol adherence and characteristics between cohorts.

Methods: FeSS variables compared: 1) paracetamol <1 hour of first temperature >37.5°C; 2) insulin <1 hour of blood glucose level (BGL) >10mmol/L; and 3) swallow screen (<4 hours, <24 hours and before food, fluids or oral medication). Trial and audit hospitals were compared by remoteness and stroke unit presence.

Results: Baseline adherence appeared lower in trial hospitals for variables 1 (42% trial vs 44% audit) and 2 (23% trial vs 27% audit). However, for variable 3, adherence appeared higher (<4 hours: 33% trial vs 27% audit; <24 hours: 64% trial vs 60% audit; before oral intake: 64% trial vs 60% audit). Hospitals were in major cities (60% trial vs 54% audit) and had stroke units (90% trial vs 80% audit).

Conclusion: FeSS Protocol adherence and hospital characteristics were broadly similar between trial and audit hospitals, and not clinically significant. These findings suggest good baseline comparability and highlight that in routine practice, protocol adherence remains suboptimal, reinforcing the need for targeted implementation strategies to improve adherence.

Relevance to clinical practice or patient experience: The persistent evidence to practice gaps underscore the urgent need for targeted implementation strategies to improve the quality of acute stroke care in Australian hospitals. Improved adherence means more patients receive evidence-based care, leading to better outcomes.