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Simple stroke care protocols now going international

Professor Sandy Middleton

Australian Catholic University | 2005 / 2012 | $405,450 / $2,382,003

Stroke, caused by a clot or bleed in the brain, is Australia’s second biggest cause of death and the leading cause of disability.1

Implementation of evidence is key in caring for patients suffering a stroke. Patients are 16 per cent more likely to be alive and independent three months later if clinicians are supported to implement standard protocols to manage fever, sugar levels and swallowing difficulties.

Professor Sandy Middleton—Director of the Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia—is the lead researcher of a collaboration which trialled an implementation strategy to promote uptake of standard protocols in 19 acute stroke units across New South Wales, with more than 1600 patients.

These protocols were successfully implemented in all 36 NSW stroke services. Six years later, these protocols are now going to be introduced into over 300 hospitals in 12 European countries, and care according to these protocols was recently added as a strong recommendation in the NHMRC Australian Clinical Guidelines for Stroke Management 2017.

‘This is a landmark trial clearly demonstrating that evidence-based nursing care is crucial for improving the lives of stroke patients. It is an example of doing simple things well,’ Professor Middleton said.

A recent independent economic evaluation of this work by the Australian Commission on Safety and Quality in Healthcare found that if only 65 per cent of the eligible Australian population received care according to these protocols, there would be a saving of $281 million over 12 months.

‘If we can implement care according to these protocols, not only can we reduce death and disability, we can make substantial savings for the health care system. It’s a compelling lesson to think about what other care we could improve on using evidence from research we already have, and the resulting incremental gains we could have for our patients.

‘Getting clinician-practice change in hospitals locally and in Europe is an excellent example of both national and international impact as a result of this trial funded by the NHMRC.’

For Professor Middleton, collaborating with universities and health agencies was ‘absolutely critical’ to receiving and implementing these NHMRC Project Grants.                                                                                       

This type of grant helps to create new knowledge by funding the best investigator-initiated research project plan between one and five years in any area relevant to human health.

Professor Middleton, who also received a postgraduate scholarship from the NHMRC in 2001 to launch her research career, is focused on nurse-led interventions to improve patient outcomes. She is working to help strengthen the research culture in nursing and support quality care.

‘This work clearly shows the importance of national funding for health services research and, in particular, implementation research—examining how to get evidence into routine clinical practice,’ she said.


1Australian Institute of Health and Welfare 2016. Australia’s Health