Authors (including presenting author) :
LO PS(1), WONG CW(1), LUI ML(1)
Affiliation :
Operating Theatre, Department of Anaesthesia, Pamela Youde Nethersole Eastern Hospital
Introduction :
Intra-arterial mechanical thrombectomy (IAMT) is a treatment for patients eligible for acute ischaemic strokes (AIS) due to large vessel occlusions. Green channel was set to reduce any treatment delay within the therapeutic window. We looked into delineating nursing roles in IAMT service for OR settings. PYNEH OR has been supporting this emergency service when radiology suites are occupied or off-hour. OR nurses extended their competencies and compiled our care pathway in this high-pressure endovascular procedure, to shorten the preparation time by as much as possible
Objectives :
To share the experiences of the multi-faceted role development of nurses in expanding the emergency IAMT services in OR settings.
Methodology :
Responding to a 120-minute door-to-groin puncture time, from 2024 OT, we particularly looked into in-house logistics, and recorded OR readiness to review waiting times in between door-to-puncture times. A guided protocol was set and discussed in this study with diagrams, to shorten attending times for the green channel of IAMT service.
Result & Outcome :
We completed 87 cases of IAMT starting from November 2021. 32 were performed with time-log records from January 2024 for continuous quality control. Mean theatre preparation time by OT nurses was around 16 minutes, after minimal essential theatre setup. All patients attended IAMT services in OT after booking within 60 minutes – complying with the performance pledge for desperate cases. In 2024, 22 out of 32 cases could attend OT services less than 30 minutes from booking. With a time-log form for IAMT service, we continued monitoring the booking-to-puncture times. Approximately 57 minutes were required. Mean attending time to OT was approximately 27 minutes – 15 minutes to proceed to OR for intervention after booking. Mean transportation time was 12 minutes. This was because a majority – 18/32 – of the potential cases were early identified LVO by neurosurgeons during CTA, with phone notifications to OT shift in-charge prior to OTMS bookings. CTA was in progress. Meanwhile, OR was prepared. All OT staff were trained for the basic operation of Hybrid OR.The operating team adhered to surgical safety checking without exception and started the IAMT procedure approximately 24 minutes after OT arrival. Strategies for continuous quality improvement are crucial in IAMT. These include theatre preparation workflows, care process monitoring (e.g. OR time metrics monitoring), and multi-discipline team collaboration. Nurse role development is also essential to execute the green channel of IAMT procedure safely and efficiently.