Authors (including presenting author) :
Karin Chow(1), Raymond Leung(1), Michael FU(1), Kelvin Tsoi(1), Jimmy SIU(2), NTWC Stroke team(2)
Affiliation :
(1)Acute Stroke Unit, Tuen Mun Hospital, (2)Diagnostic and Raidology Department, Tune Mun Hospital, (3)NTWC Comprehensive Stroke Centre, Subcommittee of TMH Neuroscience Centre
Introduction :
Stroke green channels are critical for expediting acute stroke care by minimizing delays in diagnosis and treatment. While officially established in June 2024, the foundation of this cultural transformation was laid in January 2024, with the first audit revealing improving trends in door-to-needle time (DNT) and door-to-puncture time (DPT).
Objectives :
Prior to 2024, more than five years of data showed a plateau in key performance indicators (KPIs) for DNT and DPT, despite multiple workflow adjustments. Inspired by the National Stroke Centre’s green channel strategies, we sought to bridge interdepartmental gaps and achieve consistent DNT < 45 minutes and DPT < 90 minutes on a 24/7 basis. Unlike fast-track workflows, which optimize departmental processes through protocols and parallel steps, green channels represent a cultural change. This value system is embraced by healthcare workers and the public, eliminating the need for step-by-step approvals. Every "door" in the care pathway is ready for patients to pass through seamlessly, fostering patient-centered, timely interventions.
Methodology :
A multidisciplinary Stroke Green Channel sub-group—including emergency medicine, radiology, and neurology representatives—was established in early 2024. Guided by the Plan-Do-Study-Act model, the following strategies were implemented:
1. Streamlined Activation: A single-call to reach all experts
2. Real-Time Smart-Communication: A shared platform in cluster-basis enabling seamless decision-making across stakeholders.
3. Guided Pathways: Clear signage from hospital entrances to AED registration for optimized navigation and speed transportation, same floor to provide all-in-one procedures .
4. Clear Goals – Clear Roles with defined Time Metrics: Specific responsibilities and time benchmarks for all team members, including nurses, doctors, clerks, and portering staff.
5. Cluster-level governance: Standards with ongoing audits to monitor progress and refine workflows.
Primary outcomes included DNT and DPT differences between 2023 and 2024. Post-hoc analysis in 6-month intervals was performed using one-way ANOVA.
Result & Outcome :
A total of 130 patients were included pre-implementation (2023) and 167 post-implementation (2024). Median DNT improved from 64.5 minutes (interquartile range [IQR]: 56.0–74.3) to 47.5 minutes (IQR: 37.0–62.3) [figure 1], with the percentage achieving DNT ≤ 45 minutes increasing from 7.7% to 43.5% (absolute improvement [AI]: 35.9%, 95% CI: 25.1–45.4%, p<0.001). Post-hoc analysis showed significant improvement since June 2024 (p<0.003). Median DPT decreased from 130 minutes (IQR: 96.8–147.8) to 99 minutes (IQR: 60–121) [figure 2], with the percentage achieving DPT ≤ 90 minutes rising from 14.8% to 39.1% (AI: 24.3%, 95% CI: 8.4–38.1%, p= 0.006). Post-hoc analysis revealed significant improvement starting in January 2024 (p=0.005). These results highlight the significant impact of the cultural shift, even before the green channel was officially launched.
Conclusion
Stroke green channels represent a cultural transformation, driven by engagement across all stakeholders. This approach has broken through the plateau observed in KPIs for over five years, achieving unprecedented improvements in DNT and DPT.
Unlike protocol-driven fast-track workflows, green channels prioritize a shared value system, ensuring readiness at every step without requiring approval for each stage. This cultural shift empowers healthcare teams to deliver faster and more effective care as benchmark to National Stroke Centre. Green channels offer a scalable model for other critical conditions in AED, where timely interventions are vital. By fostering readiness, collaboration, and patient-centered care, green channels can revolutionize acute care delivery, ensuring better outcomes across disciplines.
