Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Cheung CCC(1), Hau FC(1), Sheng B(1)(2), Wu HF(2), Chin LSA(1), Lam MW(1), Ng PM(1), Lam LP(1), Leung LL(1), Tam ML(1), Lo TW(1), Lau ST(1), Tam SM(1)
Affiliation :
1Integrated Neurosurgery and Neurology Ward, Department of Neurosurgery, Princess Margaret Hospital (PMH), Kowloon West Cluster 2Department of Medicine & Geriatrics, Princess Margaret Hospital, Kowloon West Cluster
Introduction :
Reperfusion therapy, i.e. intravenous thrombolysis (IVT) and IAMT, in hyperacute stroke management for acute ischaemic stroke patients aims at optimizing patient outcomes, by timely restoration of blood flow to salvageable ischaemic penumbra. IVT is the mainstay of reperfusion therapy, while IAMT is indicated for an ischaemic stroke caused by large vessel occlusion (LVO) in the proximal anterior circulation. PMH has been providing 24/7 IVT and weekdays’ 8am-8pm IAMT service since 2016 and 2021 respectively. To prepare expansion to 24/7 IAMT service by 3Q2023 and in view of increasing number of IAMT cases, revised workflow and in-house checklist for case preparation were used. PMH started to roll-out 24/7 IAMT service since 31Jul2023.
Objectives :
• To minimize transport time between plain CT brain (CTB) and CT angiogram & perfusion (CTA+P) in patients with suspected LVO by revising current workflow, to triage stroke patients for eligibility of mode of reperfusion therapy and selection of imaging modality by stroke nurse assessment • To facilitate stroke nurses in handling cases, both PMH and transfer-in from other KWC hospitals, effectively and efficiently with the in-house checklist
Methodology :
• Pilot use of revised workflow with CT-CTA coupling since Dec2022 in PMH, selection of imaging modality regarding to stroke nurse assessment on patient’s NIHSS and premorbid status by modified Rankin Scale (mRS). Not only plain CT brain are performed, subsequent contrast CTA+P will be done together for acute ischaemic stroke patients with good functional premorbid status and suspected LVO in Accident and Emergency Department (AED). Patients who are eligible for IAMT are given IVT bridging directly at AED if indicated and then directly transferred to Angiosuite for IAMT. It aims to minimize door-toCTA time and to enhance door-to-groin time in eligible IAMT cases, which were previously assessed and managed in ward after admission. • In-house checklist for IAMT cases was designed for catering PMH and transfer-in cases from other KWC hospitals, during office and non-office hour. PMH stroke nurse is the liaison among different parties, including AED / other hospitals, Neurologist, acute stroke unit, Radiology department and HDU/ICU. It aims to provide a step-by-step guide for case handover and preparation.
Result & Outcome :
• PMH catered 78 IAMT cases in 2023, 48 of them were performed after 24/7 IAMT commenced on 31Jul2023. The number of IAMT cases markedly increased, compared to 28 cases in 2022. • Mean time-lag between CTB and CTA+P reduced to 12 minutes from 164 minutes after revised workflow with CT-CTA coupling was used. • Compared to door-to-groin time (DTG) during office hours in PMH, mean DTG in 2023 was 98 min while in 2022 was 142 min
