Authors (including presenting author) :
Lo SM, Yiu HC, Lam KW, Boo MS, Cheng KF
Affiliation :
Department of Neurosurgery, Queen Mary Hospital, Hong Kong
Introduction :
Stroke is the fifth leading cause of death in Hong Kong . “Time is brain” when a stroke arrives. In patients with large vessel acute ischemic stroke, 1.9 million neurons and 14 billion synapses are lost each minute without intervention. About a decade ago, Intra-arterial thrombectomy (IAT) became the gold standard therapy for stroke caused by major vessel occlusion. However, this process is time-dependent. In 2018, a 24-hour IAT service was established in the Queen Mary Hospital which provided emergent thrombectomy to both interhospital transfer and non-transfer patients. However, barriers were met for managing interhospital patients before arriving the angio-suite leading to an unpredictable time lag. Therefore, a project team was formed, including nurses and neurosurgeons, to explore possible solutions by the end of 2019.
Objectives :
To speed up puncture times to the target of less than 6 hours since stroke onset and eliminate unnecessary barrier.
Methodology :
After analysis of the barriers, root causes were identified. In order to improve the overall transfer process, a Quality Improvement Project, one-stop management was introduced aiming to transport the patients directly from the ambulance bay to the angio-suite. Since the transfer process is multi-tasked with involvement of multiple departments, a workflow was designed and integrated to the process in an attempt to standardize each step with more coordinated service delivery to improve the overall patient transfer process and to empower the frontline nurses and residents to tackle each step.
Result & Outcome :
Results:
A total of 112 patients were included from March 2020 to November 2024. They were transferred from seven hospitals in 5 clusters. The time from symptom onset to groin puncture was 218.6 minutes. Mean NIHSS score before IAT was 20. After IAT, the mean NIHSS score was 12. There was a 40% increase in stroke level improvement.
Conclusion:
Introduction of this one-stop management has shown effective to minimize the groin puncture time and greatly improved the level of stroke within 6 hours since onset of symptoms. This project also features small coordinated steps in parallel process. With integration of the workflow, specific roles and defined actions for frontline nurses and residents enhance their engagement and ensure their optimal performance along different steps to achieve efficiency and standardization of the overall patient transfer process.
