Poster Presentation Australian and New Zealand Stroke Organisation Conference 2026

Testing a simple nudge at scale: a registry-embedded randomised trial in the Registry of Stroke Care Quality (RES-Q) (#145)

Oyebola Fasugba 1 2 , Robert Mikulik 3 4 5 , Dominique Cadilhac 6 7 , Simeon Dale 1 2 , Rupal Sedani 5 , Miroslav Vařecha 3 , Geraldo Neto 3 , Kelly Coughlan 1 2 , Nicola Straiton 1 2 , Sandy Middleton 1 2
  1. Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne and Australian Catholic University, Australia, Darlinghurst, NSW, Australia
  2. School of Nursing Midwifery and Paramedicine, , Australian Catholic University, Sydney, NSW, Australia
  3. International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic
  4. Department of Neurology, St. Anne’s University Hospital, Brno, Czech Republic
  5. World Stroke Organization, Health Management Institute, Brno, Czech Republic
  6. Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
  7. Stroke and Critical Care theme, The Florey, University of Melbourne, Heidelberg, Victoria, Australia

Background/Aims
Audit and feedback via RES-Q can improve stroke care. We evaluated the effect of a simple prompt-based (‘nudge’) intervention on report generation (primary), dashboard use and stroke care processes (secondary outcomes).

Methods
Randomised controlled trial (ACTRN12623000633684) across 1,454 RES-Q hospitals (November 2024-October 2025). The intervention was a monthly email from the RES-Q Global Chair, encouraging use of RES-Q data and links to hospital reports and dashboards. Absolute and mean differences with 95% confidence intervals (CI) were estimated. Subgroup analyses compared active (≥10 patient entries/12 months) versus inactive (<10 patient entries/12 months) hospitals using logistic and negative binomial regression.

Results
The proportion of hospitals generating ≥1 report was similar between groups (intervention group: 35.6% vs control group: 37.0%). Among active hospitals, the frequency of report generation per hospital was higher in the intervention group (IRR=1.42; 95% CI 1.16–1.75; p=0.001), with no difference between groups in inactive hospitals (IRR=0.92; 95% CI 0.50–1.68; p=0.79). There was no significant arm‑by‑activity interaction (p=0.14). Dashboard views did not differ between groups for hospital dashboard (median difference: 6.50; 95% CI: -4.00–18.00) and WSO/ESO Angels Awards dashboard (median difference: -1.00; 95% CI: -3.00–2.00). Stroke care processes were similar between groups.

Conclusions
Although the nudge had limited overall effectiveness, it may have increased report generation frequency in active hospitals. The study demonstrates that RES-Q can support registry-embedded randomisation and evaluation across a large international hospital network. RES-Q therefore represents not only a quality improvement platform, but also a scalable infrastructure for pragmatic hospital-level randomised studies.