Most Proposed Topic :
Staff Engagement and Empowerment (motivating staff / teamwork / work revamp tackling manpower issue)
Authors: (including presenting author): :
Wong TY, Lam TY, Ng SY, Ho YK, Chan ML, Tam KM, Chan LT, Tang OL, Leung KH, Kwok FY, Yam YL, Tang Y, Hung MM, Tsang FF, Chan SY, Yu SC, Ko CM, Ip MF, Wai TY, Wong LY, Lau KY, Cai G, Choo KL, Li SH
Affiliation: :
Acute Stroke Unit, Department of Medicine, North District Hospital
Introduction: :
In-hospital stroke accounts for approximately 1% of all strokes. Studies have demonstrated that these strokes generally have worse outcomes, are more severe strokes, and pose challenges in triaging for reperfusion therapies such as intravenous thrombolysis (IVT) and endovascular therapy (EVT). Early detection and prompt activation of stroke calls are crucial for in-hospital stroke patients to receive appropriate treatment and timely reperfusion therapies.
However, the challenges to in-hospital stroke include a lack of stroke awareness, delay in stroke recognition and an inefficient care pathway. Therefore, an efficient and smart workflow of in-hospital stroke detection is pivotal.
Objectives: :
To improve the detection of strokes in hospitalized patients through ACT F.A.S.T. project.
To empower nurses and doctors from different departments to initiate stroke calls for suspected in-hospital strokes.
Methodology: :
The workflow of in-hospital stroke detection has been re-engineered since December 2021 by the ACT F.A.S.T. project.
1. Promulgation: Educational sessions and sharing sessions organized by the stroke team were conducted in all in-patient wards at NDH since December 2021. The goal was to review common signs and symptoms of stroke, increase the awareness of in-hospital stroke detection and ensure that ward nurses and doctors are familiar with the new workflow.
2. ACT F.A.S.T. checklist: An ‘ACT F.A.S.T.’ checklist was created for screening acute in-hospital strokes that are potential candidates for reperfusion therapies. The checklist provides crucial information to evaluate patients’ eligibility for reperfusion therapies.
3. Nurse-initiated stroke call activations: After completing the ‘ACT F.A.S.T.’ checklist and identifying suitable patients, it is not only doctors but also ward nurses who can activate the stroke call to directly notify the stroke team for further assessment. This workflow significantly enhances the efficiency by eliminating the need for assessment by the parent-team doctor or interdepartmental consultation.
Result & Outcome: :
Between December 2021 and June 2023, a total of 100 in-hospital stroke calls were activated, representing approximately a 2-fold increase compared to the period before ACT F.A.S.T. The number of patients receiving IVT and EVT increased by 2.5-fold and 3-fold respectively. These results indicate a significantly improved in-hospital stroke detection and a higher number of stroke patients undergoing IVT and EVT. From December 2021 to February 2023, only 28% of stroke calls were activated by nurses. This percentage subsequently increased to 33% for stroke calls from December 2021 to June 2023. These results show an increase in nurse-initiated stroke call activations over time.
The ACT F.A.S.T. project has demonstrated improvements in the awareness and detection of in-hospital strokes. The workflow effectively increases the number of stroke calls, leading to more in-hospital stroke patients receiving IVT and EVT. Additionally, it helps overcome common challenges associated with in-hospital strokes.
