Most Proposed Topic :
Clinical Safety and Quality Service I (projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors: (including presenting author): :
Yip KK(1), Lee OKA(1), Tse KY(1), Au W(1), Lam SS(1)
Affiliation: :
(1) Department of Medicine and Geriatrics (M&G), Ruttonjee & Tang Shiu Kin Hospitals
Introduction: :
Stroke becomes a major public health problem. Inpatient stroke (IPS) should be managed with high quality and safety as well as outpatients arriving from accident emergency department (AED)1. Inpatient is at higher risks and has poorer outcomes as they are usually older with comorbidities2. To provide timely intervention and improve patient outcomes, multiple elements including nursing awareness, competency, and systematic protocol are crucial to optimize the management of IPS.
Objectives: :
To formulate a standardized workflow for IPS
To raise the awareness and knowledge of IPS identification & its management
To shorten the “activation-to-needle time” and increase the rate of reperfusion therapy for inpatients, and improve patient outcomes
Methodology: :
The data was reviewed from 2019 to 2021, the IPS call was increasing trend, ranging from 6% to 14% but the rate of reperfusion therapy dropped from 19% to 15.2%. The mean of “alert to needle time” is 17.7 minutes longer than the patients who activated from AED. Hence, a series of promulgation was conducted during 2021 to 2022 including establishing an eye-catching poster with clear workflow, conducting webinar training, and organizing activities to promote stroke identification (Be a hero, spot a stroke!) for hospital staff. The rate of received reperfusion therapy, activation-to-needle time, and post-3 months modified Rankin Score (mRs) were collected to evaluate patient outcomes. A 10-MCQ knowledge was used to evaluate staff knowledge.
Result & Outcome: :
The rate of reperfusion therapy and the number of code stroke activation still dropped in 2022 when compared to 2019-2021 due to covid pandemic 2022. However, it is still significantly shortened 29 minutes in activation-to-needle time. A total of 50% patients achieved good clinical outcome (mRs >2) when compared the data in 2021 (33%). For the training quiz, it is statistically significant that the scores improved from the pre-test (M=6.95, SD=1) to post-test (M=9.65, SD=0.57) with p< 0.001.
The programme shortened the activation-to-needle time and improved staff knowledge significantly. However, further monitoring on the rate of reperfusion therapy is needed. Enlightened workflow, nursing awareness and a patient-centered approach to care are essential to build up a safety & quality culture in healthcare systems.
