Abstract WP167: Quality Improvement in Stroke Care: Evaluating Adherence to FeSS Protocols Across Multiple Hospitals

Background: Complications of fever, hyperglycemia and aspiration can have negative effects on outcomes in patients with acute stroke. The Fever, Sugar, and Swallowing (FeSS) protocol has shown to mitigate mortality and long-term disability when adhered to. Post hyper-acute management of hospital stroke care clinical practice guidelines (CPGs) support FeSS interventions that include frequent monitoring and treatment of temperatures >37.5 Celsius within 1 hour of fever, blood glucose (BG) >180 mg/dL treated within 1 hour, and screening patients for dysphagia less than 24 hours from hospital arrival. In 2025, stroke mortality was chosen as a quality initiative for a large hospital system prompting hospitals to evaluate processes that contribute to an overall reduction in mortality. Purpose: The purpose of this study was to evaluate adherence to the FeSS protocol in the stroke patient population. Methods: A standardized abstraction tool was used to evaluate frequency and treatment of temperatures, BG; and swallow screen compliance. Retrospective analysis of patients with ischemic (n=216) and hemorrhagic (n= 74) stroke was included. Three patients were excluded due to initiation of comfort care on day one. Secondary analysis included a review of system wide order sets to determine if any variations were in place that contributed to non-compliance. Results: Data from 287 patients revealed deviations in FeSS protocol adherence. The average frequency of temperature measurement was 3.4 per day compared to the recommended 4. 22% of patients had fever >37.5 (62 of 287), but only 16% (10 of 62) were treated with antipyretics. The average number of daily glucose measurements was 2.7. 29% (83 of 287) of patients had BG >180 with only 28% (23 of 83) receiving treatment with insulin. Dysphagia screening was completed in 84% of patients (242 of 287). Review of system-wide standardized order sets (Cerner/Epic) noted variation in ordered frequency of temperature and glucose assessments and treatment parameters when fever and glucose parameters exceeded protocol levels. Conclusion: Routine multidisciplinary reviews of CPGs can ensure healthcare delivery care models reflect evidence-based practice recommendations. Revisions in standardized orders should take precedence followed by timely implementation strategies when needed. Final recommendations were made to guide the national stroke team experts currently in development of standardized stroke admission order sets.