Authors (including presenting author) :
Mok YNM(1)(2), Chan YS(1), Chui KS(1), Ho PC(1), Duong KH(1), Cheng S(1), Li R(1)(2), AuYeung M(1), Cheung CM(1)(2), Pang K Y(2)
Affiliation :
(1)Department of Medicine, Pamela Youde Nethersole Eastern Hospital
(2)Cluster Clinical Neuroscience Service Committee
Introduction :
Intravenous thrombolysis (IVT) with injecting plasminogen activator (TPA) is golden standard procedure in managing eligible acute ischaemic stroke (AIS) within therapeutic time window. Decreasing IVT delay is critical for enhancing the success of thrombolytic treatment. Time delay can be affected by pre-hospital and in-hospital factors. Therefore, improvement strategies are explored to shorten the preparation time to decrease thrombolysis delay.
Objectives :
To evaluate the efficacy of implementation of improvement strategies in thrombolysis delay.
Methodology :
From 2018 onwards, in-hospital improvement strategies with 24/7 protocol-driven workflow, prompt triage in Accident Emergency Department (AED), designated Stroke Nurse Team in coordination; and urgent Computed-Tomography (CT) brain prioritised by AED and Radiology Department were implemented. Additional ambulance Pre-hospital Notification (PHN) was started since August-2021. We conducted a retrospective review to compare critical time windows of AIS patients received IVT in 2018 and 2024. All data was collected prospectively and entered in “Microsoft Excel” for analysis.
Result & Outcome :
Compared year 2018 with 2024, annual acute strokes were 967 and 864 (average about 800 to 900 via AED admission) with 723 and 661 AIS (74.8% and 76.5% of all strokes). AIS successfully received IVT from 6.64% increased to 13.8%. Comparison on critical time windows (Mean/Median): 12.6/10 and 3.7/0.0 minutes in AED Alert-to-Stroke Nurse Triage (ASNT) time; 16.5/13 and 16.9/13.5 minutes in Door-to-CT (DCT) time; 59.4/56.0 and 39.2/34.0 minutes in CT to Needle (CTN) time. IVT DTN time within 60 minutes was significantly increased from 33.3% to 77.1%.
Further review in 2024 data, 285 out of 780 acute strokes via AED admission (36.5%) activated PHN; 77 out of 110 AIS received IVT (70.0%) by PHN activation. Longer critical time windows (Mean/Median) were found in non-activation by comparison with activation of PHN: 15.4/14.0 and -0.14/-2.0 minutes in ASNT time; 20.9/16.5 and 14.2/13.0 minutes in DCT time; 41.5/35.0 and 37.6/33.0 minutes in CTN time. IVT DTN time within 60 mins in non-activation and activation of PHN were 66.7% and 81.4% (p-value <0.000016) respectively. In conclusion, it has shown that efficiency of in-hospital multidisciplinary collaboration may be a key factor in thrombolysis delay. Ambulance PHN can contribute significant decrease in delay for thrombolysis.
