Authors: (including presenting author): :
Karin YL Chow (1), Raymond Leung (1), Sammi Law (1), Nick Choi (2) NTWC Stroke nursing team (1,2,3)
Affiliation: :
(1) Department of Medicine and Geriatric, Tune Mun Hospital; (2) Department of Medicine and Geriatric, Pok Oi Hospital; (3) Department of Medicine and Geriatric, Tin Shui Wai Hospital
Keyword 1: :
Nurse-led round
Keyword 2: :
Cluster-based supervision
Keyword 3: :
Nurse consultant supervision in cluster model
Introduction: :
Fragmented ward by ward supervision across three hospitals limited alignment, diluted learning and consumed supervisory time. These challenges were exacerbated by manpower and retention pressures. The NTWC Stroke Nursing Team implemented a standardized cluster wide nurse led morning round to unify acute stroke case review, which accelerate best practice adoption and strengthen a psychologically safe learning culture.
Objectives: :
To standardize acute stroke case rounds across three hospitals and three nursing teams, we comprising 50 nurses and embed a preliminary stroke nurse triage to prioritize cases and improve engagement, supervisory, efficiency, safety and quality signals without new headcount
Methodology: :
Methodology:
From January 2025 all duty stroke nurses prepare a concise briefing for newly acute stroke admissions daily, using a shared case round framework, covering clinical pathway, time critical decisions, safety checks and operational issues. Each morning a designated stroke nurse will: 1.Collates new admissions 2.Screening for KPI sensitive including thrombolysis and thrombectomy windows, red flags for clinical risks related to neurological signs, blood pressure and glucose targets, VTE prophylaxis and neuroimaging checks. 3.Prioritize cases for discussion 4.Outline key questions and learning points. Cluster rounds are facilitated by a nurse consultant and associate consultants to coach clinical reasoning and presentation, enforce the standard template and documentation align on action items, and escalation thresholds reinforce literature pearls and verify follow through at the bedside. Implementation and Alignment: •To date 728 cases have been reviewed.
•A standard template operationalizes core measures including onset to needle and puncture timing, antithrombotic and VTE timing and post stroke complication precautions •Role clarity with stroke nurses triaging, presenters synthesizing and facilitators enforcing standards and closing actions •A single cross site forum delivered through virtual or hybrid formats replaces siloed rounds which enabled rapid calibration and consistent messaging •Micro debriefs and a shared issue tracker drive continuous improvement •Recovered travel time is reinvested into bedside huddles and service recovery
Result & Outcome: :
•Engagement and capability: Interviews with six junior stroke nurses reported improved confidence, triage discipline, presentation skills, proactive learning and team cohesion. •Efficiency: Eliminating inter site travel recaptured supervisory hours for complex cases and coaching. •Safety and quality signals: Creation of Nurse Leader Round elements including focused safety scans, health literacy teach back and service recovery supports nurse sensitive outcomes and experience. •Adoption and fidelity: Universal briefing and rotating presenters sustained participation while standardized templates reduced handover variability. •Planned Evaluation and Spread: Process measures include dysphagia screening within four hours, timely VTE prophylaxis, neuroimaging verification, documentation completeness and stroke nurse fidelity. Outcomes and experience measures include aspiration events, early mobilization readiness, closed service recovery loops, teach back documentation, and pulse surveys on engagement and safety climate. Efficiency will be measured by supervisory hours recovered. Governance occurs via the stroke centre meeting quarterly. Conclusion: A cluster-based nurse led round anchored by stroke nurse triage and a standard framework aligns practice across hospitals elevates engagement enhances efficiency and capability and shows early safety and operational benefits offering a scalable low-cost pathway to quality and workforce sustainability in acute stroke care.
