Authors: (including presenting author): :
Yeung HM (1), Chan WL, Stroke Nursing Team (1), Li SH (2), Ip MF (2), Wai TY (2), Stroke Nursing Team (2), Shum WC (3)
Affiliation: :
(1) Department of Medicine, AHNH, (2) Department of Medicine NDH, (3) Stroke Care, NTEC
Introduction: :
Intravenous (IV) thrombolysis (TPA) is the standard treatment for acute ischemic stroke (AIS) patients. From November 2018 onward, a networked call and tele-stroke program was set up to extend office-hour TPA service to 24 hours coverage in two peripheral hospitals (AHNH and NDH). Total 5 neurologists and 24 nurses were trained to use tele-stroke system for TPA delivery by off-site neurologist. Networked neurologist roster and operation protocols were standardized to facilitate inter-hospitals multi-units' collaboration. Two-years data were collected to review the effectiveness of networked tele-stroke program.
Objectives: :
Evaluate the effectiveness and efficiency of stroke thrombolysis service through networked stroke teams, tele-stroke system and multi-units collaboration in non-office hour in two hospitals.
Methodology: :
A retrospective review and comparison on TPA call and TPA deliveries at office-hour and non-office hour in the two peripheral hospitals. Outcome measurements were categorized as: 1. Extra numbers of patients benefited with extended TPA service; 2. Performance of Door-to-needle (DTN) time; 3. Key Performance Index (KPI) of % of AIS with TPA.
Result & Outcome: :
From November 2018 to October 2020, total 1,254 TPA calls were received in the two hospitals, with 480 in office-hour, 774 in non-office hour (62%). Total 140 patients received IV TPA (59 vs. 81 respectively), demonstrated 1.5 times increased TPA delivery with extended non-office hour service. The mean DTN time was 61.86 minutes in office-hour, significantly shorter in comparison with 79.17 minutes in non-office hour (p< 0.01). In average, the KPI of percentage of AIS with TPA increased from 4.25% (year 2017-2018) to 7.59% (year 2019-2020) in the two hospitals. The result demonstrated that networked stroke team collaboration successfully facilitates the extension of 24 hours TPA service in peripheral hospitals. The extension resulted 1.5 times increase of AIS patients received standard thrombolysis treatment, with 80% improvement Stroke KPI.
