Authors (including presenting author) :
Choi YH(1), Cheung KY(2), Fu YP(3), Tsoi LK(3), Chow YL(4), Yuen WH(5), NTWC Stroke Nursing Team(4)
Affiliation :
(1) Department of Medicines and Geriatrics, Pok Oi Hospital/New Territories West Cluster, (2) Department of Medicines and Geriatrics, Pok Oi Hospital and Tin Shui Wai Hospital/ New Territories West Cluster, (3) Department of Medicines and Geriatrics, Tuen Mun Hospital/New Territories West Cluster, (4) New Territories West Cluster, (5) Department of Medicines and Geriatrics, Pok Oi Hospital
Keyword 3: :
Hyperacute Stroke
Keyword 4: :
Acute Stroke
Introduction :
Hyperacute and acute stroke service in Pok Oi Hospital has evolved in the past 5 years to accommodate the increasing need for quality stroke care and evidenced based practice in stroke care. A retrospective review on stroke service development and performance is conducted.
Objectives :
Stroke service development in Hong Kong has evolved in the past 10 years. Pok Oi Hospital (POH), as a regional hospital, takes care of the growing population of Yuen Long district. With the increasing need and demand for quality and evidence-based stroke care, service model has evolved and role of stroke nurse has expanded much from focusing on care in hospitalized stroke patients to coordinating holistic care through-out stroke journey: from pre-admission health education to post-discharge stroke services referral which promotes reintegration of stroke survivors into community and social context.
Methodology :
In Alignment with New Territories West Cluster (NTWC) stroke service development and enhancement, the implementation of Green Channel and enhanced workflow for stroke patients has streamlined assessment and management of stroke patients attending Emergency department. Commencement of Pre-Hospital Notification since August 2th, 2021 also allows more swift response of stroke team in Hyperacute Phase of stroke. In-Hospital Stroke awareness and management education has also been promoted among nursing staff in the past 5 years. Implementation of stroke nursing note documentation empowers nurses to screen for post-discharge care need of our stroke survivors, including referrals to District Health Centres (DHC), post-discharge support group and pharmacist cardio-vascular clinic.
Result & Outcome :
Since the implementation of 24/7 Hyperacute stroke service - Intravenous Thrombolysis for acute ischemic stroke in Feb, 2019, the number of stroke calls responded by stroke nurses has increased from 148 calls in 2020 to 795 calls in 2025. Following the implementation of enhanced stroke call workflow in NTWC and green channel promotion, the average Door-to-needle (DTN) time has been enhanced from 76 minutes in 2020 to 57.6 minutes in 2025, achieving the goal of DTN < 60 minutes. At the same time, in-hospital stroke awareness education is promoted through Yearly World Stroke Day events and stroke-related education series. E-Learning of In-Hospital Stroke Awareness module has been promoted to 100% completion in Department of Medicines and Geriatrics by 2024 and still on-going to ensure all new nurse graduates and new-comers complete the module. Stroke calls from in-patient sources have risen from 16 in 2020 to 151 in 2025, showing an increased awareness among nursing staff. The average onset-to-detection time has improved by 52% over these years, reflecting an improving trend in early detection and swift response to in-hospital stroke. The implementation of electronic stroke nursing note documentation started in phases since 2019. In addition to providing stroke nursing care in acute phase, it is a routine for stroke nurses to screen every stroke patient for post-discharge support care need. For example, DHC service and primary health care is introduced, and stroke patients are encouraged to enroll and join Community Rehabilitation Program or Patient Empowerment Program. Conclusion: Stroke is a major cause of morbidity and mortality in Hong Kong. Continuous enhancement of stroke service and public health education are important. While pre-hospital stroke notification expedites management of stroke occurring in the community, In-hospital stroke awareness education empowers enhanced stroke detection to improve patient outcome.
