Our people

Professor Sandy Middleton

Director, Nursing Research Institute

Areas of expertise: nursing research, stroke, implementation science research

ORCID ID:  0000-0002-7201-4394

Phone: +61 2 8382 3790

Email: nriadmin@acu.edu.au

Location: ACU North Sydney Campus

Sandy Middleton is Professor of Nursing, and Director of the Nursing Research Institute at St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne and Australian Catholic University. She is a National Health and Medical Research Council Leadership Fellow. Professor Middleton has led a 15 year program of stroke research evaluating how to implement evidence-based stroke care. She has obtained 115 grants totalling $109.3M. Professor Middleton is Director of the Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPERE) Nursing and Midwifery Implementation Science Academy. She is also Chair of the Steering Committee of the Australian Stroke Clinical Registry. She is a Fellow of the Australian Academy of Health and Medical Sciences. In November 2023, Professor Middleton was awarded the 2023 American Heart Association on Cardiovascular and Stroke Nursing (CVSN) Stroke Council ‘Stroke Article of the Year Award’ for leading the Quality in Acute Stroke Care (QASC) Europe study in 64 hospitals within 17 European countries. Additionally, in November 2023, Professor Sandy Middleton and the other Assessment and CommuniCation ExcelLEnce foR sAfe paTient outcomEs Plus (ACCELERATE Plus) investigators, won the ‘2023 Australian Clinical Trials Alliance Consumer Involvement Award’ for the ACCELERATE Plus Trial: a stepped-wedge cluster randomised controlled trial to assess the effect of improving patient assessment and clinical communication on patient adverse events. She also was a finalist in the Engagement Australia Excellence Awards 2022, for Outstanding Engagement for Research Impact for the QASC research program.

Select publications

• Teede H, Cadilhac DA, Purvis T, Kilkenny MF, Campbell B, English C, Callander E, Grimley RS, Levi C, Middleton S, Hill K, Enticott J. Learning together for better health using an evidence-based Learning Health Systems framework: A case study in stroke. BMC Medicine 2024; 22:198. https://doi.org/10.1186/s12916-024-03416-w
• Bladin C, Cheung NW, Dewey H, Churilov L, Middleton S, Thijs V, Ekinci E, Levi C, Lindley R, Donnan G, Parsons M, Meretoja A, Tiainen M, Choi P, Cordato D, Brown H, Campbell B, Davis S, Cloud G, Grimley R, Lee-Archer M, Ghia D, Sanders L, Markus R, Muller C, Salvaris P, Wu T, Fink J. Management of post-stroke hyperglycaemia:the Treatment with Exenatide in Acute Ischaemic Stroke (TEXAIS) randomised trial. Stroke 2023; 54(12): 2962-2971. https://doi.org/10.1161/STROKEAHA.123.044568
  ** Included in the Center for Biomedical Research Transparency (CBMRT) online Null Hypothesis Collection **Liu M, Whittam S, Thornton A, Goncharov L, Slade D, McElduff B, Kelly P, Law CK, Walsh S, Pollnow V, Cuffe J, McMahon J, Aggar C, Bilo J, Bowen K, Chow JSF, Duffy K, Everett B, Ferguson C, Frost SA, Gleeson N, Hackett K, Komusanac I, Marshall S, May S, McErlean G, Melbourne G, Murphy J, Newbury J, Newman D, Rihari-Thomas J, Sciuriaga H, Sturgess L, Taylor J, Tuqiri K, McInnes E, Middleton S on behalf of the ACCELERATE Plus Project Team. Assessment and Communication Excellence for Safe Patient Outcomes (ACCELERATE) Plus Trial Protocol: A stepped-wedge cluster randomised trial, cost-benefit analysis, and process evaluation. BMC Nursing. 2023; 22(8):e125-e132. https://doi.org/10.1186/s12912-023-01439-x
• Fasugba O, Sedani R, Mikulik R, Dale S, Vařecha M, Coughlan K, McElduff B, McInnes E, Hladíková S, Cadilhac DA, Middleton S. How registry data are used to inform activities for stroke care quality improvement across 55 countries: A cross-sectional survey of Registry of Stroke Care Quality (RES-Q) hospitals. European Journal of Neurology 2024; 31:e16024. https://doi.org/10.1111/ene.16024
• Johnson M, Ferguson C, Thornton A, Israel J, Cruickshank M, Debono D, Fernandez R, Fry M, Hickman LD, Hoise A, Inglis SC, McErlean G, McInnes E, Perry L, Sheppard-Law S, Wynne R, Parsons M, Middleton S. Exploring the SPHERE Nursing and Midwifery Clinician Researcher Career Pathway: A qualitative study. Collegian 2023; 30(6):795-804. https://doi.org/10.1016/j.colegn.2023.06.002
• Lynch EA, Bulto L, Cheng H, Craig L, Luker JA, Bagot K, Thayabaranathan T, Janssen H, McInnes E, Middleton S, Cadilhac DA. Interventions for the uptake of evidence-based recommendations in acute stroke settings. Cochrane Effective Practice and Organisation of Care. Issue 8. Art. No.: CD012520. https://doi.org/10.1002/14651858.CD012520.pub2
• Jones B, Fasugba O, Dale S, Burrows C, John M, Doncillo M, Wright S, Lueck C, D’Este C, McElduff B, McInnes E, Middleton S. Improving stroke Emergency Department nursing care: The Code Stroke 2.0 pre-test/post-test feasibility study. Collegian. 2023; 30(5):736-743. https://doi.org/10.1016/j.colegn.2023.04.002
• Fasugba O, Dale S, McInnes E, Cadilhac D, Noetel M, Coughlan K, McElduff B, Kim J,  Langley T, Cheung W, Hill K,  Pollnow V,  Page K, Sanjuan E, Neal E, Griffith S,  Christie L,  Slark J, Ranta, Levi C, Grimshaw J, Middleton S. Evaluating remote facilitation intensity for multi-national translation of nurse-initiated stroke protocols (QASC Australasia): A protocol for a cluster randomised controlled trial. Implementation Science 2023; 18:2. https://doi.org/10.1186/s13012-023-01260-9
• Eckert M, Kennedy K, Neylon K, Rickard CM, Keogh S, Gray R,Middleton S, Homer C, Whitehead L, Sharplin G. A scoping review of nurse-led randomised controlled trials. Journal of Clinical Nursing 2023; 32:5550-5561. https://doi.org/10.1111/jocn.16632
• Middleton S, Dale S, McElduff B, Coughlan K, McInnes E, Mikulik R, Fischer T, van der Merwe J, Cadilac DA, E’Este C, Levi C, Grimshaw J, Grecu A, Quinn C, Cheung N, Koláčná T, Medukhanova S, Sanjuan E, Salselas S, Messchendor G, Cassier-Woidasky AK, Skrzypec-Czerko M, Slavat-Plana M, Urso A, Pfeilschifter W. Translation of nurse-initiated protocols to manage fever, hyperglycaemia, and swallowing following stroke across Europe (QASC Europe): a pre-test/post-test implementation study. European Stroke Journal 2023; 8:132-147. https://doi.org/10.1177/23969873221126027
• ** Winner 2023 American Heart Association Council on Cardiovascular & Stroke Nursing Stroke Article of the Year **
• Rihari-Thomas J, Whittam S, Goncharov L, Slade D, McElduff B, Pritchard T, McMahon J, Coventry A, Coughlan K, Steadward Y, Taylor J, Thornton A, Riddell K, Tuqiri K, Oleson K, Dahm M, Chien L, Kelly P, McInnes E, Middleton S. Assessment and communication excellence for safe patient outcomes (ACCELERATE): A stepped-wedge cluster randomised trial protocol. Collegian 2022; 29(5):799-805. https://doi.org/10.1016/j.colegn.2022.06.006
• Coote S, Mackay E, Alexandrov AW, Cadilhac DA, Alexandrov AV, Easton D, Zhao H, Langenberg F, Bivard A, Stephenson M, Parsons MW, Campbell BCV, Donnan GA, Davis SM, Middleton S. The Mobile Stroke Unit Nurse: An International Exploration of Their Scope of Practice, Education, and Training. Journal of Neuroscience Nursing 2022; 54(2):61-67. https://doi.org/10.1097/JNN.0000000000000632
• Hamilton H, Dale S, McElduff B, Craig LE, Fasugba O, McInnes E, Alexandrov AW, Cadilhac DA, Lightbody E, Watkins C, Middleton S. The role of stroke nurses in thrombolysis administration in Australia and the United Kingdom: A cross-sectional survey of current practice. Journal of Clinical Nursing 2022; 31:158–166. https://doi.org/10.1111/jocn.15892
• Middleton S, Dale S, McElduff B, Coughlan K, McInnes E, Mikulik R, Fischer T, van der Merwe J, Cadilac DA, E’Este C, Levi C, Grimshaw J, Grecu A, Quinn C, Cheung N, Koláčná T, Medukhanova S, Sanjuan E, Salselas S, Messchendor G, Cassier-Woidasky AK, Skrzypec-Czerko M, Slavat-Plana M, Urso A, Pfeilschifter W. Translation of nurse-initiated protocols to manage fever, hyperglycaemia and swallowing following stroke across Europe (QASC Europe): A pre-test/post-test implementation study. European Stroke Journal 2023; 8(10):132-147. https://doi.org/10.1177/23969873221126027
• Purvis T, Middleton S, Alexandrov A, Kilkenny M, Coote S, Kuhle S, Cadilhac DA. Exploring barriers to stroke coordinator roles in Australia: A national survey. Collegian 2022; 29(4):423-429. https://doi.org/10.1016/j.colegn.2021.12.007
• Eckert M, Rickard C, Forsythe D, Baird K, Finn J, Gilkinson A, Gray R, Homer C, Middleton S, Neville S, Whitehead L, Sharplin GE, Keogh S. Harnessing nursing and midwifery workforce to boost Australia’s clinical research impact. Medical Journal of Australia 2022; 217:514-516. https://doi.org/10.5694/mja2.51758
• Fish JA, Rickard CM, Gray R, Middleton S, Homer C, Keogh S, Leslie G, Nemeh F, Neville S, Sharplin G, Whitehead L, Yates P, Eckert M. Nurse- and midwife-led trials in Australia and New Zealand: Scoping review protocol. Collegian 2022; 29(5): 793-798. https://doi.org/10.1016/j.colegn.2022.05.005
• Middleton S, Dale S, Cheung W, Cadilhac D, Grimshaw J, Levi C, McInnes E, Considine J, McElduff P, Gerraty R, Craig L, Schadewaldt V, Fitzgerald M, Quinn C, Cadigan G, Denisenko S, Longworth M, Ward J, D’Este C. Nurse-initiated acute stroke care in Emergency Departments: Results from the T3 implementation cluster randomised controlled trial. Stroke 2019; 50:1346-1355. https://doi.org/10.1161/STROKEAHA.118.020701
• Middleton S, McElduff P, Ward J, Grimshaw J, Dale S, D’Este C, Drury P, Griffiths R, Cheung NW, Quinn C, Evans M, Cadilhac D, Levi C. Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia and swallowing dysfunction in acute stroke improves 90-day outcomes: QASC, a cluster randomised controlled trial. The Lancet 2011; 378(9804):1699-1706. Published online October 12: 1-8. https://doi.org/10.1016/S0140-6736(11)61485-2
• ***** Commentary also published in The Lancet ***** See: Wolfe CDA and Rudd AG. Improvement of Care in Acute Stroke Units. The Lancet 2011; 378 (9804): 1679. Published online 12 October 2011. https://doi.org/10.1016/S0140-6736(11)61545-6
• ***** Published in Faculty 1000 (F1000) Library as a result of post-publication peer review which places this work in the library of the top 2% of published articles in biology and medicine available at http://f1000.com/13399002. *****

Accolades and awards

• Feb 2024 - Winner, 2023 Translation Award at the Australian Cardiovascular Alliance (ACvA) Excellence in Cardiovascular Research for the Quality in Acute Stoke Care (QASC) Project
• Nov 2023 - Winner, 2023 Australian Clinical Trials Alliance (ACTA) Consumer Involvement Award for ACCELERATE Plus Trial: a stepped-wedge cluster randomised controlled trial to assess the effect of improving patient assessment and clinical communication on patient adverse events (ACCELERATE Plus Trial)
• Nov 2023 - Winner, 2023 American Heart Association Council on Cardiovascular and Stroke Nursing (CVSN) Stroke Article of the Year Award. Scientific Sessions, Philadelphia, Pennsylvania. 11-13 November 2023.
• Oct 2023 - Stanford University Top 2% of scientists by Field of Research Code.
• Nov 2022 - Finalist, Engagement Australia 2022 Excellence Awards - Award for Outstanding Engagement for Research Impact for the Quality in Acute Stroke Care (QASC) Program.
• Nov 2021 - World Stroke Academy - #WomenInStroke initiative for outstanding work and achievements in the field of stroke.
• July 2020 - Winner, Illawarra Shoalhaven Local Health District Quality and Innovation Awards for Health Research and Innovation category (Category 9). Implementation of a chest Injury Care Bundle Prevents Adverse Events Project. 30 July 2020.
• Oct 2019 - Winner, Vice-Chancellor’s Staff Excellence Award, Excellence in Research and Research Partnerships for the Quality in Acute Stroke Care (QASC) Program. 16 October 2019.
• Oct 2019 - Fellow, Australian Academy of Health and Medical Sciences. 10 October 2019.
• August 2019 – Finalist, Excellence in Research and Research Partnerships category, Vice-Chancellor's Staff Excellence Awards.
• April 2019 - Finalist, Federal Health Minister’s inaugural Award for Nursing Trailblazers.
• November 2018 - Winner, Health Collaboration Awards: Service Delivery Category for The Angels Initiative (QASC Europe). European Federation of Pharmaceutical Industries and Associations (EFPIA), 8th November 2018.
• November 2018 - Honoree, St Vincent’s Clinic Medal for Outstanding Contribution to St Vincent’s Clinic. Sydney, Australia, 21st November 2018.
• October 2017- Fellow, American Academy of Nursing. Academy’s 2017 Transforming Health, Driving Policy Conference. Washington DC, 5th – 7th October 2017.
• July 2017 - Honoree, 2017 International Nurse Researcher Hall of Fame. Honor Society of Nursing, Sigma Theta Tau International. 28th International Nursing Research Congress. Dublin, Ireland, 27th-31st July 2017.
• Nov 2014 - Winner, 2014 NSW Premier's Public-Sector Award for Improving Performance and Accountability. Quality in Acute Stroke Care Implementation Project.
• Oct 2014 - Finalist, NSW Health Awards 2014, Translational Research. Quality in Acute Stroke Care Implementation Project.
• Sept 2014 - Winner, NSW Health Excellence in Nursing and Midwifery Awards 2014. Excellence in Innovation Research.
• World Stroke Academy - #WomenInStroke initiative for outstanding work and achievements in the field of stroke.

Appointments and affiliations

Member, AuSDAT Data and Benchmarking Working Group Dataset Subcommittee, February 2024 to present.
Member, Asia Pacific Stroke Conference (APSC) International Advisory Board, January 2024 to present.
Member, Clinical and Lived Experience Working Group for the development of the Advanced Digital Registry Platform for Stroke, September 2023 to present.
Member, IS Scientific Advisor Group for IMPACT Implementation Science Advisory Board, September 2023 to present.
Chair, Australian Commission on Safety and Quality in Health Care Clinical Quality Registries Framework Review Advisory Group, December 2022 to present.
Member, Australian College of Nursing Emerging Nurse Research Leadership Program – Expert Advisory Group, June 2022 to present.
Member, RES-Q Scientific Committee, May 2021 to present.
Member, St Vincent’s Health Australia Board Research and Education Committee (Research component only), September 2020 to present.
Member, Australian Stroke Alliance Strategic Advisory Council, August 2020 to present.
Member, Australian Academy of Health and Medical Sciences Fellowship Selection Committee, Nov 2019 to present.
Member, Living Evidence Business Case Development Steering Committee, August 2019 to present.
Member, Quality Stroke Service Awards Subcommittee, 2019 to present.
Chair, Nursing and Midwifery Implementation Science Academy, 2018 to present.
Director, Implementation Science Platform for Maridulu Budaryi Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), NHMRC accredited Advanced Health Research Translation Centre, 2018 to present.
Member, Translational Research Fellowship Committee for Maridulu Budaryi Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), NHMRC accredited Advanced Health Research Translation Centre, 2018 to present.
Member, Clinical Trials Conduct: Clinician, Public and Patient Involvement Steering Committee. Maridulu Budaryi Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), NHMRC accredited Advanced Health Research Translation Centre, 2018 to present
Member, NSW Agency for Clinical Innovation Stroke Service NSW Executive Committee, July 2018 to present.
Chair, NSW Health Stroke Ambulance Research Sub-committee, 2018 to present.
Member, European Stroke Organisation Conference (ESOC), 2018 Allied Health (and Nursing) Sub-committee.
Member, American Heart Association Nursing Symposium Scientific Committee 2018, 2019.
Member, Royal Australasian College of Surgeons Clinical Researcher Committee (representing Australian College of Nursing), 2021 to present.
Member, Stroke Foundation Living Guidelines Steering Committee, July 2018 to present.
Member, Stroke Foundation, Living Guidelines Stroke Development Working Group, 2018 to present.
Co-Chair, Stroke Foundation, Living Guidelines Stroke Development Nursing Sub-committee Working Group, 2018 to present.
Member, Executive Committee for the TEXAIS trial, 2017 to present.
Member, St Vincent’s Health Sydney Local Health District, Nursing Advisory Council, October 2015 to present.
Member, Clinical Excellence Commission Board of Directors, March 2014 to March 2024.
Member, Australian Stroke Coalition Executive Committee, 2013 to present.
Member, Agency for Clinical Innovation Research and Education Committee, November 2011 to present. Chair, March 2022 to present.
Member, Clinical Excellence Commission Research Committee, November 2011 to present.
Member, St Vincent’s Health Network Sydney Research Advisory Council, September 2011 to present.
Chair, Australian Clinical Stroke Registry Steering Committee, October 2008 to present.

Editorial roles

• International Editorial Board and Section Editor for ‘Stroke Clinician’. Interventional Neurology Journal, August 2017 to present.
• International Editorial Board. Journal of Advanced Nursing, October 2012 to present.