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Triage, treatment and transfer of patients with stroke in emergency department trial (the T(3) Trial): a cluster randomised trial protocol

Middleton, Sandy, Levi, Chris, Dale, Simeon, Cheung, N. Wah, McInnes, Elizabeth, Considine, Julie, D'Este, Catherine, Cadilhac, Dominique A., Grimshaw, Jeremy, Gerraty, Richard, Craig, Louise, Schadewaldt, Verena, McElduff, Patrick, Fitzgerald, Mark, Quinn, Clare, Cadigan, Greg, Denisenko, Sonia, Longworth, Mark and Ward, Jeanette 2016, Triage, treatment and transfer of patients with stroke in emergency department trial (the T(3) Trial): a cluster randomised trial protocol, Implementation science, vol. 11, Article number: 139, pp. 1-9, doi: 10.1186/s13012-016-0503-6.

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Title Triage, treatment and transfer of patients with stroke in emergency department trial (the T(3) Trial): a cluster randomised trial protocol
Formatted title Triage, treatment and transfer of patients with stroke in emergency department trial (the T(³) Trial): a cluster randomised trial protocol
Author(s) Middleton, Sandy
Levi, Chris
Dale, Simeon
Cheung, N. Wah
McInnes, Elizabeth
Considine, JulieORCID iD for Considine, Julie orcid.org/0000-0003-3801-2456
D'Este, Catherine
Cadilhac, Dominique A.
Grimshaw, Jeremy
Gerraty, Richard
Craig, Louise
Schadewaldt, Verena
McElduff, Patrick
Fitzgerald, Mark
Quinn, Clare
Cadigan, Greg
Denisenko, Sonia
Longworth, Mark
Ward, Jeanette
Journal name Implementation science
Volume number 11
Season Article number: 139
Start page 1
End page 9
Total pages 9
Publisher BioMed Central
Place of publication London, Eng.
Publication date 2016-10-18
ISSN 1748-5908
Keyword(s) cluster randomised trial
stroke
nurse-led
fever
hyperglycaemia
dysphagia
thrombolysis
theoretical domains framework
implementation science
care bundle
Summary BACKGROUND: Internationally recognised evidence-based guidelines recommend appropriate triage of patients with stroke in emergency departments (EDs), administration of tissue plasminogen activator (tPA), and proactive management of fever, hyperglycaemia and swallowing before prompt transfer to a stroke unit to maximise outcomes. We aim to evaluate the effectiveness in EDs of a theory-informed, nurse-initiated, intervention to improve multidisciplinary triage, treatment and transfer (T(3)) of patients with acute stroke to improve 90-day death and dependency. Organisational and contextual factors associated with intervention uptake also will be evaluated.

METHODS: This prospective, multicentre, parallel group, cluster randomised trial with blinded outcome assessment will be conducted in EDs of hospitals with stroke units in three Australian states and one territory. EDs will be randomised 1:1 within strata defined by state and tPA volume to receive either the T(3) intervention or no additional support (control EDs). Our T(3) intervention comprises an evidence-based care bundle targeting: (1) triage: routine assignment of patients with suspected stroke to Australian Triage Scale category 1 or 2; (2) treatment: screening for tPA eligibility and administration of tPA where applicable; instigation of protocols for management of fever, hyperglycaemia and swallowing; and (3) transfer: prompt admission to the stroke unit. We will use implementation science behaviour change methods informed by the Theoretical Domains Framework [1, 2] consisting of (i) workshops to determine barriers and local solutions; (ii) mixed interactive and didactic education; (iii) local clinical opinion leaders; and (iv) reminders in the form of email, telephone and site visits. Our primary outcome measure is 90 days post-admission death or dependency (modified Rankin Scale >2). Secondary outcomes are health status (SF-36), functional dependency (Barthel Index), quality of life (EQ-5D); and quality of care outcomes, namely, monitoring and management practices for thrombolysis, fever, hyperglycaemia, swallowing and prompt transfer. Outcomes will be assessed at the patient level. A separate process evaluation will examine contextual factors to successful intervention uptake. At the time of publication, EDs have been randomised and the intervention is being implemented.

DISCUSSION: This theoretically informed intervention is aimed at addressing important gaps in care to maximise 90-day health outcomes for patients with stroke.
Notes Prepared by the authors on behalf of the T3 Trialist Collaborators.
Language eng
DOI 10.1186/s13012-016-0503-6
Field of Research 111003 Clinical Nursing: Secondary (Acute Care)
Socio Economic Objective 920210 Nursing
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Grant ID APP1024812
Copyright notice ©2016, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30089040

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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.