Authors (including presenting author) :
Wong NTB(1), Keung PM(1), Au-Yeung WT(1), Cheung YT(2), Wong MSG(2), Wong TF(2), Lam WM(3)
Affiliation :
(1) Accident and Emergency department, Tseung Kwan O Hospital, (2) Accident and Emergency department, Queen Mary Hospital, (3) Accident and Emergency department, Ruttonjee & Tang Shiu Kin Hospital
Introduction :
This study focused on promoting the use of the "BEFAST" mnemonic for early detection of stroke patients during triage in three accident and emergency department (AED) in Hong Kong. By conducting a structured education program, which aimed at enhancing the knowledge and skills of AED nurses in stroke assessment. The door-to-call time of Stroke Team was significantly reduced. Consequently, a positive patient outcome was validated that more potential stroke cases could be early identified during the triage phase.
Objectives :
Stroke remained as a significant cause of morbidity and mortality worldwide. The traditional "FAST" mnemonic was widely used for stroke identification. However, the posterior circulation strokes (PCS) could not be prevalently detected by "FAST". By containing the assessment on the "Balance (B)" and "Eye(E)" symptoms, the "BEFAST" tool was relatively comprehensive and has shown a revamp in diagnostic accuracy for all types of strokes, including PCS. Promulgation of using "BEFAST" would be beneficial in early recognizing of acute stroke patients in emergency settings.
Methodology :
This study adopted a Continuous Quality Improvement (CQI) approach by executing a Plan-Do-Study-Act (PDSA) cycle throughout the process. Apart from gap analysis and the design of the educational interventions targeted on emergency nurses, the evaluations were well-organized. A pre-test questionnaire on "BEFAST" knowledge was carried out followed by a serial educational intervention, including informative slide show, video demonstration on performing "BEFAST" and the distribution of the "BEFAST" cue cards. A post-test questionnaire was arranged to nurse after they completed all interventions. The pre and post intervention data collection questionnaires were conducted via Google Forms for easy access. Nurses' knowledge and the effectiveness of training could be systematically revealed.
Result & Outcome :
The "BEFAST" education program significantly boosted nurse' knowledge level in stroke assessment. The pre and post intervention tests compared a notable increase in correct responses, indicating a better understanding and application of the "BEFAST" tool. Moreover, the implementation of "BEFAST" showed a reduced in the "Door-to-Call Stroke Team time" in one of the AED. The appropriateness of triage categories made by nurses was remarkably increased which potentially improved patient outcomes.
The "BEFAST" mnemonic was proven to be a more effective tool than "FAST” for early stroke detection, particularly for PCS. The educational interventions successfully enhanced emergency nurses' ability to recognize stroke symptoms promptly and accurately.
