Nurses lead pioneering programme to improve health outcomes for stroke patients

The Nursing Research Institute (NRI), at St Vincent’s Health Australia Sydney, St Vincent’s Hospital, Melbourne & Australian Catholic University, Australia is leading progress in nurse-initiated efforts to improve outcomes for patients who have suffered a stroke.  

Previous research by the NRI demonstrated that when nurses introduce clinical protocols to manage fever, hyperglycaemia and swallowing within stroke units, there was a 16% reduction in death and dependency 90-days after experiencing a stroke.1 Patients cared for in these stroke units also were 20% less likely to have died four years following their stroke.2 

In 2017, an independent economic evaluation conducted by Australian Commission on Safety and Quality in Healthcare determined that if the these protocols were implemented in 65% of the eligible Australian patient populations for one year, the total saving would be $281 million.3 This Australian programme of clinical research has transformed stroke nursing practice by providing new high-level evidence for the importance of nursing care to manage fever, hyperglycaemia and swallowing difficulties in stroke patients. 

Working in collaboration with the European Stroke Organisation and the Angels Initiative, the NRI is undertaking an evidence translation programme, the Quality in Acute Stroke Care (QASC) Europe Project, to implement these protocols in 18 countries across Europe (Belarus, Bulgaria, Czech Republic, France, Georgia, Germany, Hungary, Italy, Kazakhstan, Macedonia, Moldova, Poland, Portugal, Romania, Russia, Slovakia, Spain and  Ukraine). Many of the participating hospitals are from resource-poor countries that do not have access to the latest stroke therapies including thrombolysis medication nor thrombectomy. Hence, the introduction of these evidence-based nursing care protocols will make a significant difference in reducing death and disability after stroke.

For many nurses across Europe, this is the first time they have participated in a quality improvement project and have the opportunity to use this experience and the associated lessons learned in similar work in the future. 

The QASC Europe project supportive model of care is designed to maximise the potential of the nursing healthcare workforce. Empowering nurses by arming them with knowledge and resources to advocate best clinical practice at the local level is a critical step to improving health for all.

For more information, contact: Professor Sandy Middleton, Director, Nursing Research Institute:


  1. Middleton S, McElduff P, Ward J, Grimshaw J, Dale S, D’Este C, et al. Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): a cluster randomised controlled trial. Lancet 2011; 378(9804):1699-706.
  2. Middleton S, Coughlan K, Mnatzaganian G, Choy N, Dale S, Jammali-Blasi A, et al. Mortality reduction for fever, hyperglycaemia and swallowing nurse-initiated stroke intervention: QASC trial follow-up. Stroke 2017; 48(5):1331-6.

3. Australian Clinical Trials Alliance. Economic evaluation of investigator-initiated clinical trials conducted by networks. Australian Commission on Safety and Quality in Healthcare 2017. Available from: