Authors (including presenting author) :
Mok M(1), Yip KY(1), Lee TY(1), Chan YS(1), Lo HY(1), Li R(1), Cheng S(1), Cheung CM(1)
Affiliation :
(1)Department of Medicine, Pamela Youde Nethersole Eastern Hospital
Introduction :
“Time is brain” emphasizes the urgency of stroke care. In general, we always focus more on out-of-hospital onset strokes. However, in-patient strokes are relatively common, especially following surgical procedures or in patients with cardiac disorders. Despite staff education and a well-developed code stroke algorithm, in-patient strokes are still under-recognized or under-reported. Delays in immediate in-patient stroke management result in patients missing out possible interventional therapies and lead to poor outcomes. Raising awareness of in-patient stroke is therefore crucial.
Objectives :
To raise in-patient stroke awareness for earlier activation of code stroke assessment and possible intervention
Methodology :
Since 2019, Pamela Youde Nethersole Eastern Hospital (PYNEH) developed an in-patient code stroke algorithm which assigned Stroke Nurse as the coordinator. A series of “In-patient Stroke Awareness Promotion Strategies” (IPSAPS) were also implemented, including: i) In-patient workflow poster design; ii) Roadshow promotion with poster distribution to all Medical wards; iii) Yearly cluster World Stroke Day activities to promote acute stroke symptoms - “FAST”; iv) Simulation training sessions on emergency management and care for in-patient Stroke to cluster ward nurses; and v) Using screensaver with “FAST” promotion in cluster hospital clinical computers. A retrospective review was then conducted to compare the response to PYNEH in-patient strokes between 2018 to 2022.
Result & Outcome :
Between 2018 and 2022, the annual number of acute strokes ranged between 900 and 1000. 6% were in-patient strokes, with 70% to 83% occurring in Medical wards and >93% of ischaemic cause. After implementation of IPSAPS, in-patient Code Stroke activation rate increased from 35.4% to 74.2% of all in-patient strokes. In-patient ischaemic strokes that have successfully received hyperacute stroke intervention increased from 3 to 7 per year, which corresponded to a rise from 5.0% to 13.7% of the in-patient ischaemic strokes in 4 years. Consistent reduction in mean time to computed tomographic scan from 84.9 (10-379) to 64.8 (18-152) minutes was observed. In conclusion, a series of sustained IPSAPS can enhance ward nurse awareness to in-patient stroke. The positive figures reinforced the important role of Stroke Nurse as a coordinator in the management of in-patient stroke care.
