Implementation of three clinical protocols dramatically improves stroke patient outcomes (National Stroke Foundation)

Acute stroke patients who receive three clinical protocols to manage fever, sugar and swallowing are 16 percent more likely to be alive and independent three months later - a collaborative research study led by Professor Sandy Middleton, National Stroke Foundation Clinical Council member and Director of the Nursing Research Institute at the Australian Catholic University and St Vincents & Mater Health Sydney has found. This research has provided critical data demonstrating significant improvements for the management of patients following stroke.

Stroke is caused by a clot or a bleed in the brain and is Australia’s second biggest cause of death and leading cause of disability. While a patient suffers irreversible brain damage as a result of the stroke, there is potential to salvage surrounding brain tissue and limit the damage by effectively managing fever, sugar and swallowing.

The NHMRC-funded trial is the first nurse-led trial in acute stroke of its kind carried out in Australia and involved 19 acute stroke units across New South Wales and more than 1,600 patients.

The trial developed, implemented and evaluated the effectiveness of team-building workshops and education to introduce three clinical protocols to manage fever, sugar and swallowing (the FeSS protocols) following an acute stroke.

“Patients admitted with an acute stroke to hospitals that were randomised to receive our support to implement these FeSS protocols, were 16 percent more likely to be alive and independent at 90 days.” Professor Middleton said.
“These results are better than any current drug or treatment for stroke including clot busting therapy, and can be universally applied in acute stroke units.”

Published online today in The Lancet, the study showed that patients who received care in stroke units using these protocols were also more likely to have fewer episodes of fever, lower average temperatures and sugar levels, and better screening for swallowing difficulties.

“We found better outcomes for patients and consistently better processes of care in these hospitals because we created opportunities for teams to come together and agree on what they could do as an integrated service to improve quality of care. These results provide some of the best evidence to date in Australia on how to change clinicians’ behaviour and also evidence for effectiveteam work and good nursing care.”Professor Middleton said.

“Good management of fever, high blood sugar levels and swallowing can salvage brain tissue - poor management however can result in extension of the stroke and have devastating consequences for the patient.”

The study was a collaboration between the Australian Catholic University, the University of Newcastle, the University of Ottawa, the University of Western Sydney, the University of Sydney and the University of Melbourne, as well as a team of clinicians from NSW Health and support from the Agency for Clinical Innovation’s Stroke Services NSW.

The National Stroke Foundation is encouraging the delivery of such programs in Australian stroke units to support the use of the FeSS protocols based on the success of Professor Middleton’s trial.

“Recovery after a stroke can be significantly improved when health professionals are supported to implement protocols that ensure consistent and prompt clinical management of these three factors – fever, blood sugar levels and swallowing. Stroke is Australia’s second leading cause of death and a major cause of disability. The delivery of programs resulting in improved care for stroke care is critical in ensuring more Australians survive stroke, and that costs associated with stroke care are minimised.” says CEO Dr Erin Lalor.

Professor Middleton said she had been delighted to find so many stroke units eager to step up and adopt best practice. “This is great news for evidence-based health care.”

Overnight leadership doesn’t happen overnight

Imaging Partners Online was established in response to a national and international shortage of radiologists and increasing demands for after-hours radiology. Almost 5 years later, IPO reports over 4,000 urgent CT scans every month and leads the way in measuring quality and service levels.

In the first month of operations in 2007, with only one afterhours client, Imaging Partners Online
reported 19 urgent, after hours CT scans.

IPO now reports over 4,000 urgent CT scans and 40,000 routine examinations every month for some 80 hospitals and clinics across Australia and the UK.

While a lot has changed at Imaging Partners Online after almost 5 years, there are some things that haven’t changed. True to its founding principles,radiology reporting at IPO is always performed in dedicated reporting centres and always in the radiologist’s normal waking hours.

Now with fully equipped and staffed reporting centres in Sydney, Melbourne, Perth, London and Leicester, IPO ensures that reporting is performed in an environment and a time-zone that gives
the best chance of a quality radiology report.

Regardless of location, all IPO radiologists are FRANZCR and registered in all Australian states. Multiple sites in multiple countries also provide important system redundancy.

At any given hour of the day or night, up to 6 IPO radiologists and a team of Quality Assurance and IT staff is dedicated to reporting every urgent case in the shortest possible time. Quality is measured and maintained through an extensive peer review process, an initiative that has been embraced by IPO’s 50+ radiologists.

‘We’re proud of what we have achieved’ says Founder and CEO of Imaging Partners Online, Bob Sheraton, ‘but I think we’re entering a new phase. The ability to provide a quality 24x7
reporting service is no longer in question. The ongoing challenge for us is to find new or better ways to integrate with our client hospitals and in doing so, lead the way in adding value to our clients.’

It’s all in the timing…

Imaging Partners Online provides urgent, off-site reporting for over 70 hospitals and clinics and has been running its ‘around the clock’ service for over four years. Its unique workflow and in-house developed IT has been honed to ensure that every study is reported to a high standard and in the shortest possible time. A rigorous peer review and quality assurance program reinforces that quality and timeliness are equally important at Imaging Partners Online. 

24 hours in the life… A typical day in an Imaging Partners Online reporting centre never ends.... ever!

 That’s because cases are reported by radiologists in London, Sydney, Melbourne and Perth using international time zones to ensure that radiologists are always reporting during their ‘awake’ hours from a fully equipped and supported reporting centre. 

Imaging Partners Online technology, supporting best practice

 Peer review is a cornerstone of modern day radiology, giving definition to the concept of ‘quality’ and ensuring that radiologists are constantly learning about their strengths and weaknesses. Imaging Partners Online has recognised the need to support peer review and to provide feedback to both its radiologists and its clients. To assist with this, Imaging Partners Online has developed its own software, IPO QA.

Imaging Partners Online United Kingdom wins University College London Hospital out of hours CT reporting contract

Are Australia’s Hospitals Providing a 2nd Tier Imaging Service for After Hours Patients?

An increasing trend occurring in many of Australia’s public and private hospitals is having urgent imaging studies taken for after hours emergency patients, read and reported by radiologists in their homes. Apart from any other considerations the first image that comes to mind is a half-asleep radiologist dragged out of bed (sometimes on 3 or 4 occasions per night) to respond to a call asking him or her to report a case of a patient who has been brought into Emergency. The radiologist ... Read More

Ensuring quality in radiology reporting

In three years’ time, hospital radiology departments will be “running to stand still” according to the latest market intelligence. In order to meet the increase in demand, the off-site reading market is predicted to grow from £7 m to £74 m in just five years. LOUISE FRAMPTON looks at how one independent sector provider is striving to address this need. Read more