Authors (including presenting author) :
Lau LH(1), Lai CY(1), Tse OS(1), Choi YH(1), Yeung KP(1), Mok CW(1), Wong CK(1), Chan KY(1), Lam KM(1), Wong KC(1), Mak NH(1), Tam WL(1), Yuen WH(1), Shiu KL(1)
Affiliation :
(1)Acute Stroke Unit, Department of Medicine and Geriatrics, Pok Oi Hospital, NTWC
Introduction :
Pok Oi Hospital (POH) serves Yuen Long district with a population of over 600,000. Stroke, always leave a burden to health system worldwide. “Time is brain”, the extent of viable brain tissue decreases with time. Recombinant tissue plasminogen activator (rtPA) is the mainstay treatment for acute ischemic stroke. Numerous studies suggested that patients suffered from acute ischemic stroke would have optimal recovery if reperfusion therapy could be achieved within 3-4.5 hours since onset. Early thrombolytic therapy requires coordination of different departments. POH piloted 12hr TPA service since Nov, 2018 and successfully extended to 24hr service in Feb, 2019.
Objectives :
1. To keep TPA service/ overall stroke performance up to international standard 2. To implement 24hr TPA service in POH 3. To enhance stroke nurse development
Methodology :
1. Multidisciplinary stakeholders: neurologists, stroke nurse, radiology, AED, ICU staffs, IT & admin. 2. Introduction of stroke nurse role in AED TPA call service since Nov, 2018. 3. Regular data review and periodic meetings were arranged to monitor the call system logistic 4. Continuous staff training and clinical provision
Result & Outcome :
1. Review Period: 18th Nov, 2018 – 31st Dec, 2019. Total 184 TPA calls, in which 149 calls were triggered in AED. 2. Number of calls per month: 6.5 (12hr TPA service); 15.8 (24hr TPA service) 3. 64 eligible patients received intravenous thrombolysis in AED immediately. 4. Average stroke nurse arrival time: 2.98 minutes (12hr TPA service); 2.04 minutes (24hr TPA service) 5. Mean door to CTB time: 17.42 minutes (12hr TPA service); 17.28 minutes (24hr TPA service) 6. Average door to needle time(DTN): 80.1 minutes (12hr TPA service); 74 minutes (24hr TPA service) 7. Overall functional outcome of patient given rtPA in POH: 67% improved; 6.25% same. 8. Number of qualified stroke nurse: 3 (12hr TPA service); 12 (24hr TPA service). Conclusion: The successful implementation of 24/7 TPA service in POH with multidisciplinary support is pivotal in enhancing stroke service development. DTN improved and patients have better functional outcome. Additionally, the new service contributes the development of stroke specialty nurse and greatly enhances their career path.
