Querying Stroke Unit Nursing Interventions in the Emergency Department

Study Overview
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Brief Summary
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The aim of the study is to monitor if specialized stroke nurses as team partners in the ED can reduce hospital acquired infections. The study is designed as pre- post-intervention study in which specialized SU nurses partner with ED nursing staff to asses and screen stroke admissions in the ED.

Detailed Description
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An intervention study comprised of 1) a primary registry database component and 2) a secondary questionnaire based quantitative evaluation . The intervention study includes a 3-month baseline observational period followed by a 7-month baseline data collection period, a 2-month intervention implementation phase, and a 3-month intervention observational period followed by 7-month intervention data collection period. An intervention, where dedicated stroke nurses handle acute care of stroke and TIA patient in the ED prior to admission to a dedicated stroke unit will take place in the timeframe of 11-19:00 hrs, 7 days a week. Notably, the intervention is set to be integrated into clinical practice on a permanent basis after end of study. Data for all stroke patients admitted to the ED at HGH are collected during the 3-month baseline and intervention observational periods. Fulfilment of Danish Stroke Quality Program (DAP) quality indicators is monitored as follows - use of dysphagia screen (GUSS), mobilization within day of ED admission and transfer to SU. Additional nursing interventions monitored in the ED are: Use of nasogastric catheter, use of bladder scan and intermittent catheterization, frequency of temperature monitoring and use of anti-pyretics, acute phase monitoring of blood-pressure every 2 hours, use of Scandinavian Stroke Scale (SSS) score. Outcomes are monitored in hospital and at visits to the out patient clinic, as well as by registry.

Official Title
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Specialized Stroke Unit Nursing Interventions in the Emergency Department and Their Efficacy on Outcomes and Patient Perceptions of Clinical Care Pathway Coherence

Conditions
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Stroke, TIA

Intervention / Treatment
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* Behavioral: Dedicated stroke nurse care in ED


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients referred to the ED at Herlev Hospital with a diagnosis of stroke or TIA from 11 Am to 7 PM patients fulfilling one of the following ICD-10 codes at discharge: ICH: I61, cerebral infarction; I63, unspecified: I64, TIA: G45 and a scheduled follow-up appointment at the outpatient clinic Herlev Hospital Exclusion criteria: Patients transferred from other hospitals or stroke units Patients elegible for thrombolysis or thrombectomy at time of admission
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Baseline period<br>Usual care. Stroke patients admitted to the ED during the 3-month baseline inclusion period. | Behavioral: Dedicated stroke nurse care in ED<br>* A specialized SU nursing team partner with ED nursing staff for timely fulfillment of stroke quality care indicators while awationg admission to a dedicated stroke unit<br>|
| Intervention period<br>Intervention: 2 month implementation period of specialized stroke nurses allocated to ED for nurse specific treatment of stroke patients specific observations and care | Behavioral: Dedicated stroke nurse care in ED<br>* A specialized SU nursing team partner with ED nursing staff for timely fulfillment of stroke quality care indicators while awationg admission to a dedicated stroke unit<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of infections | Incidence of pneumonia and urinary tract infections defined by a combination of clinical symptoms and para-clinical tests. | 7 days from admission | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 30-day mortality or recurrent cerebrovascular event | Composite measure of mortality, cerebrovascular or cardiovascular incidence | 30 days from first admission | 
| Rate of re-admission within 30 days | Number of re-admission for any disease post stroke | 30 days from first admission | 
| Number of patients with post stroke depression | new onset depression and antidepressant prescriptions within 90 days and 1 year from stroke | baseline and 90 days and 1 year after admission | 
| Level of 90-day post-stroke dependency | via modified Rankin Scale (mRS) score (0-6, 0=best) | baseline and 90 days from admission | 
| Mental health | WHO-Five Well-Being index | within 90 days from admission | 
| Length of stay | Total time of hospital admission | 90 days from admission | 
| Dependency | Barthel Index | Within 90 days from admission |