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) :
Karin Chow (1), Dr Michael Fu (1), Dr Jimmy Siu (2), Dr Chi MS (1), NTWC stroke nursing team (1)
Affiliation :
(1) Medicine & Geriactrics, TMH, (2) Diagnostic & Nuclear Medicine, NTWC
Introduction :
In this study, we aim to evaluate the effectiveness and efficiency of our approach in delivering high-quality stroke care.
Objectives :
Objectives
Through this analysis, we can gain valuable insights into how our cluster-based interdisciplinary approach, which optimizes workflow and eliminates the sole reliance on neurologist and neuro-interventionalist onsite support amongst 3 hopsitals, transforms stroke care by providing sustainable cluster-based 24/7 endovascular therapy (EVT) services and improving patient outcomes
Methodology :
Methods
Records of 344 consecutive ischemic stroke patients who had undergone EVT between 2019 to 2023 by TMH were retrospectively reviewed. We compared the total number of patients received EVT , of which, total 228 #patients were divided into four groups: pre-intervention (2019–Sept/2020 – 9-5 service of EVT), interim-intervention (Oct/2020-Sept/2021 – 8-8service of EVT), revamp-intervention for 24/7 EVT service (Oct/2021-2022) and post-intervention (2023), we compared door-to-CT brain angiogram time (DCTA), door-to-groin-puncture time (DPT) and the impact on DPT after transformed the service from 9-5 to 24/7 services between four groups using descriptive statistics.
Result & Outcome :
Results
Our findings indicate that process optimization measures could increase the access of EVT to our cluster of acute stroke patients by 3.5 folds from 33 to 117 per year; shortened DCTA by 22 min from 61 to 39 min during office-hour; by 49 min from 88 to 39 min during non-office-hours (median, P < 0.05). DPT was shortened by 22 min from 124 to 102 min during office hour; by 20 min from 168 to 148 min during non-office hour.
Conclusion
This study demonstrated that multidisciplinary cooperation was associated with increased access of EVT and shortened DPT, despite challenges posed to the healthcare system such as the inter-hospitals transportation, lack of onsite expertise for potential EVT candidate stratification, or even the COVID-19 pandemic. These practice paradigms may be transported to other stroke centers and healthcare providers to improve endovascular time metrics and patient outcomes.
