How did Stroke Nurse Team (SNT) Streamline Acute Stroke Care Service in a Hong Kong Regional Hospital?

Abstract Description

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Authors (including presenting author) :

Mok M(1), Yip KY(1), Lee TY(1), Chan YS(1), Wong D(1), Leung CY(1), Cho HY(1), Lo E(1), Li R(1), Cheung CM(1)

Affiliation :

(1)Department of Medicine, Pamela Youde Nethersole Eastern Hospital

Introduction :

Owing to the growing of stroke incidence and relative shortage of neurologists, we need skill mix of experienced nurses for central coordination to deliver high quality patient-centered stroke care. In our hospital, well-trained Stroke Nurse (SN) has challenge of stepping into new roles to support new services such as 24/7 intravenous (IV) Thrombolysis (TPA) and Transient Ischaemic Attack (TIA) Clinic since 2011. More importantly, some operational changes had to be associated with SN service to make things effective. In 2014, SN will not be “too isolated” but instead, a SNT was formulated. SNs work together for rotation of all different jobs with Neurology Team support for catering 24 hours comprehensive stroke care service.

Objectives :

To evaluate the effectiveness of SNT in streamlining acute and hyperacute stroke care service

Methodology :

We conducted a retrospective review on acute stroke admissions from year 2011 to 2017 in our PYNEH stroke database. All data was collected prospectively and analysed by Microsoft Excel.

Result & Outcome :

Compared the year 2011 with 2017, number of acute stroke admissions was about 950 yearly. SNs attended Accident Emergency Department (AED) stroke alerts increased from 356 to 837 times per year (235% increase); direct initiation of Computerized Tomography (CT) brain at AED increased from 55% to 79%; ever under appropriate stroke care areas increased from 70% to 80%. For hyperacute stroke service, acute ischaemic stroke received IV or intra-arterial (IA) thrombolytic treatment increased from 1.7% to 11.3% (665% increase), door-to-TPA time decreased from average 105 minutes to 69 minutes (34% decrease), door-to-TPA delivered within 60 minutes (during office hours) increased from 15.4% to 79.4% (516% increase) and result in post-TPA symptomatic intracranial haemorrhage decreased from 7.7% to < 2%. In conclusion, well-trained SNs can act as a catalyst for central coordination in acute and hyperacute stroke care service. Acute stroke response has increased TPA usage, improved door-to-TPA time, and enhanced department collaboration to streamline stroke patient care journey and enhance patient safety. Multidisciplinary team also appreciated valuable SN assessment during a stroke alert and their role in positive patient outcomes. SNs could expand their leadership skills and clinical expertise regarding the continuum of stroke care.