Authors (including presenting author) :
Lo SM, Fung NT, Yiu HC, Shek CW, Yeung SY, Tsang ACO
Introduction :
Acute ischaemic stroke occurs when an artery supplying blood to the brain is occluded, resulting from death of brain tissue and subsequent focal deficit. A delay of every minute is untreated, patient loses 1.9 million neurons.
In 2018, the American Heart Association recommended that intra-arterial thrombectomy (IAT) is the standard of care for acute ischaemic stroke caused by large vessel occlusion. However, clinical outcome is greatly dependent on time to reperfusion. Even a 15-minue delay, likelihood of good outcome is reduced by 10%.
Situation causes time consumption in transfer of patients from another hospital, which do not have 24-hour service provision of IAT, to interventional suite in our institution is not uncommon.
In view of performing timely reperfusion therapy to shorten door-to-groin puncture time and optimize clinical outcome, a structured workflow was developed by a team of nurses and neurosurgeons. Key components include (I) Decided for IAT, (II) Notification by 1st call medical officer or neurosurgeon, (III) 10 minutes before patient arrival, (IV) Patient arrival to interventional suite, and (V) Post-IAT.
Considering the benefits of the workflow, it provides one-stop transfer from primary hospital to our interventional suite. It also ensures coordination of a specialized team of nurses, neurosurgeons, neurologists, neurointerventionists, anesthetists, ambulance staff and security staff. Additionally, it greatly enhances communication and teamwork promoting consistent information and avoiding unnecessary delay. More importantly, high performance workflow is to save time and improve overall efficiency.
