Oral Presentation Smart Strokes Annual Scientific Meeting 2024

Factors influencing sustained use of Fever, Hyperglycaemia (Sugar) and Swallow (FeSS) Protocols for stroke: findings from a qualitative study of real-world implementation. (106910)

Kelly Coughlan 1 2 , Oyebola Fasugba 1 2 , Simeon Dale 1 2 , Kelvin Hill 3 , Dominique Cadilhac 4 , Sandy Middleton 1 2 , Elizabeth McInnes 1 2
  1. Nursing Research Institute , St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne and Australian Catholic University, Sydney,Melbourne, VIC,NSW, Australia
  2. School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW, Australia
  3. Stroke Foundation, Melbourne, VIC, Australia
  4. Stroke and Ageing Research, School of Clinical Sciences , Monash Health, Monash University, Melbourne, VIC, Australia

Introduction:

Less than half of Australian patients with stroke receive care in accordance with evidence-based protocols to manage fever, glucose, and swallowing (FeSS) complications. The aim of this study was to examine clinicians’ perspectives of individual and organisational factors that influenced sustainability of FeSS Protocols.

Methods:

Qualitative interviews were conducted with 14 Stroke Coordinators (or equivalent) from hospitals which had participated in the National Acute Stroke Services Audit cycles (2015-2021). The sample was stratified according to FeSS Protocol adherence composite score ranking (high and low quartiles), previous participation in a FeSS Intervention study, and geographical location. Participants were asked about factors thought to influence sustainability such as: stakeholder engagement, leadership, interprofessional relationships and workflow integration practices. Thematic analysis was undertaken, and findings were compared between hospital rankings.

Results:

Participants from hospitals with low adherence commonly reported inadequate resource allocation to drive implementation and believed this was related to low engagement from management. Interprofessional relationships were both a barrier (for hospitals with low FeSS Protocol adherence ranking) and facilitator (for hospitals with high FeSS Protocol adherence ranking). Access to larger hospitals workflow practices and resources via the telestroke model of care was an enabler for FeSS Protocols integration in smaller hospitals. Common adaptations to the FeSS Protocols was related to acceptance of the evidence for FeSS Protocols by stroke clinicians and perceived risk management.

 

Conclusion:

This study contributes to the literature for clinical practice change sustainability by identifying leadership engagement, interprofessional relationships and workflow integration practices as influential in embedding and sustaining clinical practice change for stroke management. Understanding these influences can direct future efforts towards adoption.

 

Relevance to clinical practice

Understanding clinician perspectives on factors influencing adoption of evidence based protocols to manage FeSS provides an opportunity to address these factors to optimise stroke care and improve patient outcomes.