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Presenter of 4 Presentations
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THE IMPACT OF THE IMPLEMENTATION OF CODE STROKE NURSE FOR HYPERACUTE STROKE SERVICE
Abstract
Background and Aims
Over the years, the number of stroke activations has increased due to increased public awareness through public campaigns, extended time window for re-perfusion treatment and national diversion of acute strokes to hyperacute stroke centres. The sheer volume of patients and the time-sensitive treatment has led to the need for very coordinated and prompt care approach so that every eligible patient receives the treatment in a timely manner. Thus, code stroke nurses play an integral role in leading and facilitating the acute stroke activation service.
Methods
A group of Advanced Practice Nurses (APNs) in our hospital were trained to perform the role of a code stroke nurse. A new workflow was established, embedding the code stroke nurse as the first responders in the Emergency Department (ED). They also play an integral role and work closely with the ED physicians to assess all stroke activations to determine whether to activate neurology Senior Residents (SRs) or to standdown stroke mimics.
Results
There were a total of 2007 pre-hospital stroke activations in our hospital from March 2021 to February 2022 and 357 patients received hyperacute stroke treatment. For patients who received hyperacute stroke therapy with the presence of a code stroke nurse, the door-to-needle treatment time was 10 minutes faster for thrombolysis and 17 minutes faster for door-to-groin puncture for endovascular therapy.
Conclusions
The presence of code stroke nurses reduce door-to-treatment times in acute stroke care.
USE OF AMBULATORY CARDIAC MONITORING TO REDUCE HOSPITALISATION STAY
Abstract
Background and Aims
Strokes are commonly caused by atrial fibrillation (AF) and detection of AF is paramount to secondary prevention of stroke. At Tan Tock Seng Hospital, patients presenting with stroke in which a cardioembolic cause is suspected undergo prolonged inpatient cardiac telemetry monitoring ranging from 3 days to 1 week to detect AF. This sometimes increases the length of their hospital stay as some of these patients are otherwise well and able to be discharged. The aim of this project was to reduce the length of stay for acute stroke patients requiring prolonged cardiac monitoring for detection of AF.
Methods
All patients with stroke who did not require prolonged hospitalization, but required prolonged cardiac monitoring, were identified from December 2020 to March 2022. A portable external cardiac monitoring device was attached to their chest and care instructions were given. Upon completion of monitoring, the patients returned the devices and qualitative feedback was obtained from the patients.
Results
There were 72 patients who were enrolled into this project. The median ambulatory cardiac monitoring period was 3 days and one case of paroxysmal AF was detected. This intervention has saved 226 unnecessary hospitalization days. Qualitative feedback obtained from patients were mostly positive with only a few patients having mild skin reactions to the adhesive electrodes
Conclusions
Overall, ambulatory cardiac monitoring has reduced hospitalization for patients. To improve the service, we need to source for lighter devices with better battery life and better adhesive electrodes. It is important to emphasize on skin care during patient education