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Table 1 T3 Trial intervention components

From: Process evaluation of an implementation trial to improve the triage, treatment and transfer of stroke patients in emergency departments (T3 trial): a qualitative study

T3 clinical protocols
Triage
  • All patients presenting with signs and symptoms of suspected stroke should be triaged to Australasia Triage Scale (ATS) categories 1 or 2 (seen within 10 min)
Treatment
  Thrombolysis (tissue-type plasminogen activator)
   • All patients to be assessed for thrombolysis eligibility
   • All eligible patients to receive thrombolysis
  Fever
   • All patients to have their temperature taken on admission to emergency department (ED) and then at least four hourly whilst they remain in ED
   • Treat temperature 37.5 °C or greater with paracetamol within 1 h
  Sugar
   • Formal venous (laboratory) blood glucose level (BGL) on admission to ED
   • Record finger prick BGL on ED admission and monitor finger prick BGL every 6 h (or greater if elevated)
   • Administer insulin to all patients with BGL > 10 mmol/L (180 mg/dL) within 1 h
  Swallow
   • Patients remain Nil By Mouth until a swallow screen by non-speech pathologist (SP) or swallow assessment by SP performed, i.e.:
    ◦ No oral food or fluids to be given prior to swallow screen by non-SP or swallow assessment by SP
    ◦ No oral medications administered prior to swallow screen by non-SP or swallow assessment by SP
   • All patients who fail the screen are to be assessed by a SP
Transfer
  • All patients with stroke to be discharged from ED within 4 h
  • All patients with stroke to be admitted to the hospital’s stroke unit
T3 Implementation strategy
Multidisciplinary Workshopsa
  Workshop 1 - Barriers and Enablers Assessment (one at each site, 60 min)
   • To present the details of the trial
   • To identify the local barriers and enablers
   • To identify the local site clinical champion
  Workshop 2 - Action Plan (one at each site, 60 min)
   • To discuss the action plan to address the barriers
   • To ascertain the actions already taken to address the barriers
   • To identify the new local barriers
Didactic and interactive educationa (minimum one at each site, 30 min)
  • A 20-min PowerPoint presentation and a 10-min discussion
  • An 8-min video developed by an academic ED nurse clinician/opinion leader
Use of clinical opinion leaders
  • Key national clinical opinion leaders at Workshop 1 and available as needed for any site-requested queries
  • Clinical champions from ED and stroke unit
 • Reminders
  • Reminder poster to display in ED- and pocket-sized card to attach to ID lanyard for staff
  • Proactive direct contact every 6 weeks in the form of the following:
   ◦ Site visits every 3 months (face-to-face) using an action plan
   ◦ Teleconferences every 3 months with clinical champions and site coordinator using an action plan
  • Emails—reactive and monthly proactive emails
  • Telephone support—reactive
  • Telephone support—reactive and as needed
  1. “On admission” defined as within 60 min of arrival to ED. Four hourly defined as within 4.5 h. Six hourly defined as within 6.5 h
  2. aFace-to-face multidisciplinary group sessions held at each intervention site