Authors (including presenting author) :
Tse MYM(1), Tsang TC(3), Cheung CWS(2), Chu YLE(2), Leung KK (1), Yuen YME(1), Chan KMH(1)
Affiliation :
(1)Acute Stroke Unit, Department of Medicine, Queen Mary Hospital, (2)Department of Radiology, Queen Mary Hospital, (3) Accident and Emergency Department, Queen Mary Hospital
Introduction :
Introduction: Stroke is one of the most devastating diseases worldwide with its high mortality and morbidity rate. Timely reperfusion therapy is the gold standard treatment for acute ischemic stroke and significantly improves the outcome. It can be in the form of intravenous thrombolysis and/ or intra-arterial thrombectomy (IAT). However, due to the time-dependent nature, it is highly underutilized for acute stroke patients. Pre-hospital and in-hospital delays are the major determinants in the implementation of reperfusion therapy. In hospital setting, it is recommended that all suspected stroke patients should be seen by A&E physicians within 10 minutes upon arrival to A&E. A&E nurses play a vital role in rapid recognition of stroke. Recent study suggested stroke education for A&E staff significantly improves stroke care and patients’ outcome by rapid recognition of stroke patients during triage and early access to acute stroke therapy. With the current time goal to treatment, the neuroimaging is usually initiated as soon as the patient is recognized with stroke symptoms. The computed tomography (CT) of the brain is used to rule out hemorrhage while computed tomography angiography (CTA) is used to detect any large vessel occlusion (LVO). In order to shorten the door to neuroimaging time, the CT and CTA time is targeted to be done together within 10 minutes. Coupled CT-CTA was piloted in QMH in August 2023.
Objectives :
To shorten the door-to-CTA time and the door-to-puncture time of IAT
Methodology :
1.Implement new CT-CTA coupling workflow through integration of Visual, Aphasia and Neglect (VAN) screening tool as protocol driven for coupled CT-CTA ordering. 2.Established clear protocols for fast-track CT-CTA ordering based on the screening tools 3. Training and empowering both A&E MO and Stroke Nurses with new protocol
Result & Outcome :
1.Reduced median door-to-CTA time by 45.2% from 67.5 minutes (Jan to Jul 2023) to 37 minutes (Aug to Dec 2023) 2.Reduced median door-to-puncture times by 17.8%, i.e. from 135 minutes (Jan to Jul 2023) to 111 minutes (Aug to Dec 2023)
