Development of a Fast Track Care System for Stroke Patients in Emergency Department of Phatthalung's Hospital during the Covid-19 Pandemic

Abstract

     The purpose of this action research study was to develop, between October 2020 and September 2021, a fast track care system for stroke patients during the COVID-19 outbreak at the emergency department of Phatthalung Hospital. Physicians, nurses, and staff/employees participated in the study. Medical records of patients diagnosed with stroke and urgently in the need to receive care during the COVID-19 outbreak between October 2020 and September 2021 were used to conduct the study. The research procedure was divided into 3 phases: 1) situation analysis, 2) improving patient care practices, and 3) evaluation and the development of a stroke fast track care system. Four main record forms were used to collect the data: 1) a stroke caregiver interview guideline, 2) a real-time nursing record form for emergent stroke patients, 3) a monitoring form for stroke patient care practice guidelines, and 4) an outcomes indicator form for stroke patients who received care from the new dedicated fast track care system. Descriptive statistics including frequency, percentage, mean, standard deviation and 95%CI were employed to analyze quantitative data. A content analysis was applied to analyze qualitative data.

     The situational analysis indicated problems in 3 phases. The first one was pre-hospital care, comprised as the care system for a stroke patient at the scene focusing on Covid-19 prevention, and referral system. Secondly, the caring phase in the emergency department consisted of screening for Covid-19 infection in stroke patients and caring for stroke patients concerning the prevention of Covid-19 infection. The last phase was the patient referral system to the ward, emphasizing on disease transmission. The data from the situation analysis were reflected and discussed in the workshop among the healthcare team aiming at finding solutions together with researchers. The fast track care system guideline for stroke was then developed, based on the agreements of healthcare professionals through the discussion with the researchers. The points of concern were patient's isolation, applying a mask to patient, the protective equipment of health care personnel, a suspension of rt-PA in patients with severe Covid-19, and surveillance of patients with acute ischemic stroke receiving rt-PA. The patient’s medical records were used to collect the related data. Based on the 200 patient’s medical records, the results showed that the service duration for each step during the Covid-19 epidemic was as follows. The average time for receiving health assessment from patient's arrival to the hospital was 3.60 minutes (target value ≤15 minutes). The average time from patient's arrival at the hospital to receiving brain CT was 36.40 minutes (target value ≤ 25 minutes). The average time from patient's arrival at the hospital to CT results interpretation by a radiologist was 106.14 minutes on average (target value ≤30 minutes). The average time from patient's arrival at the hospital to reporting laboratory results was 37.53 minutes (target value ≤45 minutes). The average time from patient's arrival at the hospital to receiving rt-PA was 84.85 minutes (target value ≤60 minutes). The average time from patient's arrival at the hospital to admission to the ward was 51.83 minutes (target value ≤40 minutes). Moreover, during the follow-up, after referral, 9.50% of the patients died.

     The results of this study show that the fast track care system for stroke patients can be applied to provide care for stroke patients during the patient's assessment and in the referral phase. However, the procedure of wearing personal protective equipment increases the time to provide treatment. Therefore, the fast track care system for stroke patients must be continuously developed, so to help patients receive quality care, and achieve standards.