Skip navigation
Skip navigation

Thrombolysis ImPlementation in Stroke (TIPS): evaluating the effectiveness of a strategy to increase the adoption of best evidence practice – protocol for a cluster randomised controlled trial in acute stroke care

Paul, Christine L.; Levi, Christopher R.; D'Este, Catherine; Parsons, Mark W.; Bladin, Christopher F.; Lindley, Richard; Attia, John R.; Henskens, Frans; Lalor, Erin; Longworth, Mark; Middleton, Sandy; Ryan, Annika; Kerr, Erin; Sanson-Fisher, Robert W.

Description

BACKGROUND Stroke is a leading cause of death and disability internationally. One of the three effective interventions in the acute phase of stroke care is thrombolytic therapy with tissue plasminogen activator (tPA), if given within 4.5 hours of onset to appropriate cases of ischaemic stroke. OBJECTIVES To test the effectiveness of a multi-component multidisciplinary collaborative approach compared to usual care as a strategy for increasing thrombolysis rates for all stroke patients at...[Show more]

dc.contributor.authorPaul, Christine L.
dc.contributor.authorLevi, Christopher R.
dc.contributor.authorD'Este, Catherine
dc.contributor.authorParsons, Mark W.
dc.contributor.authorBladin, Christopher F.
dc.contributor.authorLindley, Richard
dc.contributor.authorAttia, John R.
dc.contributor.authorHenskens, Frans
dc.contributor.authorLalor, Erin
dc.contributor.authorLongworth, Mark
dc.contributor.authorMiddleton, Sandy
dc.contributor.authorRyan, Annika
dc.contributor.authorKerr, Erin
dc.contributor.authorSanson-Fisher, Robert W.
dc.date.accessioned2016-01-05T03:55:54Z
dc.date.available2016-01-05T03:55:54Z
dc.identifier.issn1748-5908
dc.identifier.urihttp://hdl.handle.net/1885/95248
dc.description.abstractBACKGROUND Stroke is a leading cause of death and disability internationally. One of the three effective interventions in the acute phase of stroke care is thrombolytic therapy with tissue plasminogen activator (tPA), if given within 4.5 hours of onset to appropriate cases of ischaemic stroke. OBJECTIVES To test the effectiveness of a multi-component multidisciplinary collaborative approach compared to usual care as a strategy for increasing thrombolysis rates for all stroke patients at intervention hospitals, while maintaining accepted benchmarks for low rates of intracranial haemorrhage and high rates of functional outcomes for both groups at three months. METHODS AND DESIGN A cluster randomised controlled trial of 20 hospitals across 3 Australian states with 2 groups: multi- component multidisciplinary collaborative intervention as the experimental group and usual care as the control group. The intervention is based on behavioural theory and analysis of the steps, roles and barriers relating to rapid assessment for thrombolysis eligibility; it involves a comprehensive range of strategies addressing individual-level and system-level change at each site. The primary outcome is the difference in tPA rates between the two groups post-intervention. The secondary outcome is the proportion of tPA treated patients in both groups with good functional outcomes (modified Rankin Score (mRS <2) and the proportion with intracranial haemorrhage (mRS ≥2), compared to international benchmarks. DISCUSSION TIPS will trial a comprehensive, multi-component and multidisciplinary collaborative approach to improving thrombolysis rates at multiple sites. The trial has the potential to identify methods for optimal care which can be implemented for stroke patients during the acute phase. Study findings will include barriers and solutions to effective thrombolysis implementation and trial outcomes will be published whether significant or not. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12613000939796.
dc.publisherBioMed Central
dc.rights© 2014 Paul et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
dc.sourceImplementation Science
dc.subjectaspirin
dc.subjectaustralia
dc.subjectcooperative behavior
dc.subjectdiffusion of innovation
dc.subjectemergency medical services
dc.subjectevidence-based medicine
dc.subjectfibrinolytic agents
dc.subjecthumans
dc.subjectpatient care team
dc.subjectquality of health care
dc.subjectresearch design
dc.subjectstroke
dc.subjectthrombolytic therapy
dc.subjecttissue plasminogen activator
dc.subjecttriage
dc.subjectguideline adherence
dc.subjectpractice guidelines as topic
dc.titleThrombolysis ImPlementation in Stroke (TIPS): evaluating the effectiveness of a strategy to increase the adoption of best evidence practice – protocol for a cluster randomised controlled trial in acute stroke care
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume9
dc.date.issued2014-03-25
local.identifier.absfor110000
local.identifier.ariespublicationU3488905xPUB1256
local.publisher.urlhttp://www.biomedcentral.com/
local.type.statusPublished Version
local.contributor.affiliationPaul, Christine L., University of Newcastle, Australia
local.contributor.affiliationLevi, Christopher, John Hunter Hospital, Australia
local.contributor.affiliationD'Este, Catherine, College of Medicine, Biology and Environment, CMBE Research School of Population Health, Natl Centre for Epidemiology & Population Health, The Australian National University
local.contributor.affiliationParsons, Mark, Hunter New England Health, Australia
local.contributor.affiliationBladin, Christopher, Box Hill Hospital, Australia
local.contributor.affiliationLindley, Richard, University of Sydney, Australia
local.contributor.affiliationAttia, John R, University of Newcastle, Australia
local.contributor.affiliationHenskens, Frans, University of Newcastle, Australia
local.contributor.affiliationLalor, Erin, National Stroke Foundation, Australia
local.contributor.affiliationLongworth, Mark, Stroke Services, Australia
local.contributor.affiliationSanson-Fisher, Robert W., University of Newcastle, Australia
local.identifier.essn1748-5908
local.bibliographicCitation.issue1
local.bibliographicCitation.startpage38
local.bibliographicCitation.lastpage13
local.identifier.doi10.1186/1748-5908-9-38
dc.date.updated2016-02-24T09:58:03Z
local.identifier.scopusID2-s2.0-84900018827
local.identifier.thomsonID000335605500001
CollectionsANU Research Publications

Download

File Description SizeFormat Image
01_Paul_Thrombolysis_ImPlementation_in_2014.pdfPublished Version479.51 kBAdobe PDFThumbnail


Items in Open Research are protected by copyright, with all rights reserved, unless otherwise indicated.

Updated:  19 May 2020/ Responsible Officer:  University Librarian/ Page Contact:  Library Systems & Web Coordinator