Triage, Treatment and Transfer of patients with stroke in emergency departments trial

Welcome to the Triage, Treatment and Transfer of patients with stroke in emergency departments trials (T3 Trial) website.

If you are a clinician, on these pages you will be able to find information on the T3 Trial and access the T3 Trial resources, including the Fever, Sugar and Swallow (FeSS) protocols, advice on implementation strategies, and other useful links and resources. 

About the T3 Trial intervention 

The T3 Trial intervention aimed to change behaviour at both the individual clinician level and the organisational level.

Learn more about the intervention below. If you’d like to access further resources, you can register your details using our online form.

Register to download T3 Trial intervention components

T3 clinical protocols

All patients presenting with signs and symptoms of suspected stroke should be triaged at Australian Triage Scale (ATS) Category 1 or 2 (seen within 10 mins)

Treatment

tPA

• All patients to be assessed for tPA eligibility
• All eligible patients to receive tPA

Fever

• All patients to have their temperature taken on arrival 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 one hour

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 hours (or greater if elevated)
• Administer insulin to all patients with BGL > 10 mmol/L within one hour

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 hours
• All patients with stroke to be admitted to the hospital's stroke unit

T3 implementation strategy

Multidisciplinary Workshops^

Workshop 1 - Barriers and Enabler Assessment (one at each site, 60 minutes)

• To present details of trial
• To  identify local barriers and enablers
• To identify local site clinical champion

Workshop 2 - Action Plan (one at each site, 60 minutes)

• To discuss Action Plan
• To ascertain actions already taken
• To discover any further local barriers

Didactic and interactive education^ (minimum one at each site, 30 minutes)

• 20 minute PowerPoint presentation and 10 minute discussion
• 8 minute 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 for any site requested queries
• Clinical site champions

Reminders

• Reminder poster to display in ED and pocket sized card to attach to ID lanyard for staff
• Proactive direct contact every six weeks in the form of: Site visits every three months (face-to-face) and teleconferences every three months with clinical champions and site coordinator using action plan
• Emails – reactive and monthly proactive emails
• Telephone support – reactive

More detail

Visit the pages below to learn about the T3 trial in more depth:

• T3 publications
• T3 investigators
• Acknowledgements

Contact us

If you would like to get in contact with us, please email t3@acu.edu.au.