Authors (including presenting author) :
Chan YS(1), Mok YNM(1), Chui KS(1), Ho PC(1), Duong KH(1), Cheng WH(1), Li R(1), Wong M(3), Siu YCA(2), Cheung CM(1), Au Yeung M(1)
Affiliation :
(1)Department of Medicine, Pamela Youde Nethersole Eastern Hospital (2)Department of Accident and Emergency, Pamela Youde Nethersole Eastern Hospital
(3)Family Medicine & Primary Healthcare, Hong Kong East Cluster
Keyword 1: :
Helicopter acute stroke
Keyword 2: :
Pre-hospital notification
Keyword 3: :
Stroke nurse activation
Keyword 4: :
Key time metrics
Keyword 5: :
Reperfusion therapy
Keyword 6: :
Outlying island
Introduction :
Ambulance Pre-hospital Notification (PHN) service for acute ischemic stroke (AIS) has been implemented across all Hong Kong clusters since August 2021, increasing eligibility for thrombolysis. However, this service did not cover Hong Kong Outlying Islands (HKOI), including Cheung Chau, Lamma Island, Peng Chau, and other locations served by Government Flying Service. Most Helicopter Acute Stroke (HAS) patients from HKOI referred to Pamela Youde Nethersole Eastern Hospital (PYNEH) Accident and Emergency Department (AED) experienced delays in thrombolytic treatment. Strategies were explored to streamline thrombolysis preparation time.
Objectives :
To evaluate the effectiveness of extended PHN services with early Stroke Nurse (SN) activation on critical time metrics and reperfusion therapy rates for HAS patients from HKOI.
Methodology :
In 1Q-2024, extended PHN services to HKOI were launched. Eligible HAS patients within reperfusion time windows were transferred to PYNEH AED by helicopter under acute stroke management protocols, with early SN standby at AED. A retrospective cohort study was conducted to compare key time metrics and reperfusion therapy rates for HAS patients in 2023 (pre-extension) and 2024-2025 (post-extension). Data were prospectively collected and analysed using Microsoft Excel.
Result & Outcome :
A comparative analysis was conducted between HAS patients from HKOI in 2023 (n=25) and those receiving extended PHN services in 2024-2025 (n=45). Accuracy rate for stroke or transient ischemic attack diagnosis improved from 68% to 84.5%. The proportion of AIS patients receiving reperfusion therapy increased significantly from 33.3% to 46.8% (p< 0.05). Additionally, comparison of key time metrics (mean) showed that AED alert-to-stroke nurse triage time improved from 7.3 to -0.3 minutes (p< 0.05), and Computed Tomography (CT) to CT angiogram time decreased from 58.0 to 21.9 minutes (p< 0.05). Although the reductions in Door-to-Needle time from 61.7 to 52.6 minutes and Door-to-CT time from 17 to 14.6 minutes were not statistically significant, a trend toward shorter times was observed. In conclusion, extending PHN services to HKOI with well-established management protocols and early SN activation, significantly improves workflow efficiency and increases thrombolysis utilisation.
