Authors (including presenting author) :
Raymond LEUNG (1), Karin CHOW (1), TMH Stroke Nursing Team
Affiliation :
(1) Stroke Nursing Team, Acute Stroke Unit, Department of Medicine and Geriatrics, Tuen Mun Hospital
Introduction :
Acute Stroke Unit (ASU) is known to be the optimal setting for caring acute stroke patients with multidisciplinary collaboration. Preparing for rapid evolving local pandemic situation during 5th wave of COVID-19, Tuen Mun Hospital Stroke Nursing Team had contingency plan for patient care if ASU need to suspend admission. The plan included staff preparedness via nursing staff training and development of standardized nursing care pathway for newly admitted stroke patients to non-ASU setting. In August 2022, TMH ASU experienced a 10-day suspension of admission due to COVID-19. While newly admitted stroke patients entered non-ASU setting, nursing care standard were maintained with joined efforts of general medical ward staff and stroke nurses.
Objectives :
Demonstrate the importance of staff preparedness to maintain acute stroke services in TMH.
Methodology :
Retrospective medical record review of all stroke patients admitting to general medical wards during ASU closure period from 24th August 2022 to 2nd September 2022; Staff interview of non-ASU wards.
Result & Outcome :
Standardized nursing care pathway was distributed to all medical wards that would admit stroke patients. Stroke nurse proactively attended new stroke patients and performed initial nursing assessment. Nursing care advice were provided. Nursing staff were invited to contact stroke nurses if additional support required. Stroke nurses also helped to maintain stroke care standard by daily review of stroke patients and initiating discharge planning discussion with members of multidisciplinary stroke care team.
54 patients admitted to non-ASU wards during the period. All patients received stroke nurse assessment within 6 hours after admission. 9 patients (16.7%) received hyperacute stroke screening in emergency department and 4 patients (7.4%) received reperfusion therapies for hyperacute ischemic stroke. 72% of stabilized patients received discharge planning by stroke nurses, which 24 patients discharged directly, and 9 patients received priority rehabilitation bed arrangement. No post-stroke complication observed in affected patients.
Medical and nursing staff of non-ASU wards were interviewed after the crisis. They reported smooth operation during the period and appreciated the proactive stroke nurse involvement in initial assessment and discharge planning. They addressed the timely response of stroke nurse to urgent phone consultation for blood pressure management of stroke patients.
In conclusion, staff preparedness in advance of crisis and timely input of specialist provides foundation for TMH ASU to overcome the closure period. This event provides invaluable experience of the team and department conquers future operational challenges during and after COVID-19 pandemic.
