Authors (including presenting author) :
Lui CKV
Affiliation :
Medicine and Geriatrics, Caritas Medical Centre
Introduction :
Stroke is the leading cause of disability and mortality worldwide which affects mobility, speech and swallowing.
In the last decade, new options of acute therapy, namely intravenous thrombolysis (IVT) and intra-arterial mechanical thrombectomy (IAMT), has changed the fate of most ischemic stroke patients. Furthermore, more rehabilitation interventions have been installed to facilitate the rehabilitation progress, reduce risk of stroke recurrence, and better reintegration to community.
The whole stroke patient journey involves multiple disciplines. Tight collaboration and coordination of the patient journey in CMC is the cornerstone of delivering safe and effective service.
Objectives :
- Implement 24-hour acute reperfusion service with clear assessment and treatment pathways; enhance stroke nurse training to ensure safe delivery of the treatment
- Develop clear workflow and employ electronic communication channel to give timely and accurate information sharing amongst different departments and stakeholders in acute stroke assessment
- promulgation to all departments in CMC to increase awareness of in-patient stroke detection and referral
- pharmacist to deliver medication reconciliation and counselling to stroke patients, reinforcing drug safety and compliance
- ensure effective handover to rehabilitation wards
- new initiative of ICWM at rehabilitation wards to facilitate patient recovery
- Regular stroke team multidisciplinary meetings for knowledge sharing
- Post-discharge stroke clinic visits to enhance risk factor control and lifestyle modification, and review for any issues on reintegration to community / work rehab
Methodology :
- Align acute stroke reperfusion management with other hospitals in KWC; ensure all parties use the same language and use the same communication channels
- allocate designated area with physio monitoring, bedside equipment, IV thrombolysis kit and signage for hyperacute stroke patient
- in-patient clinical pharmacist service to enhance medication safety
- Accreditation of ASU to be the stroke training centre and PRCC practicum centre for both neurologist and stroke nurse
- Regular meetings with neurologist and stroke nurses on update of service and debriefing on selected cases
- Regular meetings with A&E on debriefing on selected cases and review any issues on work logistics and loopholes
- Enhance collaborate with rehabilitation team in CMC and stakeholders of community rehabilitation programs (clinical pathway, weekly stroke rounds, case conferences, ICWM consultation and rounds, DHC, local university collaboration)
- Provide post-discharge stroke clinic visits (neurologist, nurse, pharmacist and respiratory nurse) to stroke survivors
- Annual promulgation on management of in-patient stroke to all CMC departments
Result & Outcome :
- Number of IVT given were increased from zero in 2011 to 101 in 2023.
- Number of IAMT referred were increased from zero in 2011 to 22 in 2023
- Number of stroke call from A&E were increased from 68 in 2018 to 177 in 2023
- Number of in-patient call were increased from 7 in 2018 to 110 in 2023
- Number of neurologists were increased from 1 in 2011 to 5 in 2023
- Number of accredited stroke nurses were increased from 1 in 2011 to 18 in 2023
- Number of stroke nurse clinic attendance were around 370 per year
- Around 200 patients were referred to DHC per year
- Over 150 patients were referred to local university per programme
