Querying Stroke Unit Nursing Interventions in the Emergency Department

• Conditions: Stroke; TIA
• Interventions: Behavioral: Dedicated stroke nurse care in ED

• Registration Number: NCT04011514
• Lead Sponsor: Herlev Hospital

Brief Summary

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

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.

Study Timeline

• Study Start: 2018-09-28
• Study First Submitted: 2018-10-20
• Study First Submitted QC: 2019-07-04
• Study First Posted: 2019-07-08
• Status Verified: 2021-01
• Last Update Submitted: 2021-04-27
• Last Update Posted: 2021-04-28
• Primary Completion: 2021-09-21
• Study Completion: 2021-11-01

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 800

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

Exclusion Criteria

Not provided

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Baseline period	Dedicated stroke nurse care in ED	Usual care. Stroke patients admitted to the ED during the 3-month baseline inclusion period.
Intervention period	Dedicated stroke nurse care in ED	Intervention: 2 month implementation period of specialized stroke nurses allocated to ED for nurse specific treatment of stroke patients specific observations and care

Primary Outcome Measures

Name	Time	Method
Incidence of infections	7 days from admission	Incidence of pneumonia and urinary tract infections defined by a combination of clinical symptoms and para-clinical tests.

Secondary Outcome Measures

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

Trial Locations

Locations (1)

Department of Neurology, Herlev-Gentofte Hospital; 🇩🇰 Herlev, Denmark