Acute stroke total solution service
•Download as PPT, PDF•
0 likes•320 views
Combination of current best evidence and local healthcare capability of stroke for integration care
Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Acute stroke total solution service
Similar to Acute stroke total solution service (20)
Recently uploaded
Recently uploaded (20)
Acute stroke total solution service
- 1. Acute stroke total solution service From thrombolysis to post-acute care Show Chwan health system
- 2. Attaining rapid stroke thrombolysis within 30 min Thrombolysis bundle initiative in Show Chwan health system
- 4. Acute stroke Reputation establishment Few Nudge High risk A possible niche (3~4.5 hours)
- 5. 1st TPA locked in syndrome
- 6. Recent challenge Pass the high standard of the critical care evaluation process
- 7. EBM guidance Neurology guideline Conform the current NHI regulation Refer to the stroke bundle implemented in Helsinki and Melbourne
- 8. Bundle care coverage From door to ward 1 ． ER TPA or aspirin (door to needle) 2 ． ICU care (needle to ward)
- 10. Resources reconstruction Triage ER Doctors ER Nurses Neurologists Lab technician CT room alert ICU doctors ICU nurses Stroke nurse specialist Endovascular specialists Neurosurgeons Audit, Award, Penalty
- 11. Bundle care coverage From door to ward 1 ． ER TPA or aspirin (door to needle) 2 ． ICU care (needle to ward)
- 13. Possible advantage Form the 1st comprehensive stroke care bundle in Taiwan
- 14. Helsinki model
- 16. Meretoja 2013 Helsinski District Sea faced, capital of Finland
- 26. N o n -t r an sf er r abl e?
- 27. Meretoja 2013 I moved to Melbourne in Nov 2011
- 29. Meretoja 2013
- 30. 20 km radius Meretoja 2013
- 43. Other approach
- 45. • Admitting – Patient identification – Registration – Room assign • EMS – Delivers patient to room – Reports to nursing • Nursing – IV placement – Monitor hook-up – Vital sign monitoring – Blood glucose – Lab draw – Weight estimate of patient • Clinical Assessment – History – Medications/allergies – Identification of witness – Time of onset/last normal – Witnesses difficult to locate • Clinical Assessment (cont.) – NIHSS – Neurological Exam • Labs – PT/PTT, CBC, Creatinine – Emergent transport of bloods to lab • Imaging – Disconnect from monitor – Transport patient to CT – CT scan – Transport from CT to room – Reconnect to monitoring • Drug Preparation – Order tPA – Calculate tPA dose – Prepare tPA • Bolus and infuse tPA ISC 2012 New Orleans Problem #1: Overwhelming # of tasks to complete in 60 min
- 46. 1 2 3 4 5 6 Emergent Unit 1 Nursing Station Trauma Critical Care CT CT Ambulance Bay Problem #2: Inefficient choreography ISC 2012 New Orleans
- 47. Problem #3: Labs take too long • Labs needed for tPA – Platelets – INR (PT/PTT) – Blood glucose • On average, in 2010, it took 33 min to get results after ordering labs ISC 2012 New Orleans
- 50. Show Chwan model A possible niche market
- 51. Show Chwan model Stroke TPA Action Treatment group (STAT) Within the guidance of NHI: <3 hours, many outdated exclusion Rearrange the workflow STAT team member training
- 52. Suggestion Triage dispatching Inform neurologist (get the mobile phone number of the ambulance) Arrange admission and registration ICU booking Check CT room Inform Point of care lab staff (INR, glucose, platelet)
- 53. Suggestion ER doctor Check list and pre-ordered order Verify duration Check vital signs Basic NE: MP, Babinski POC video demo if needed (out of hour neurologist)
- 54. Video source and permit signing Signature from 2 patient’s family or friends Telephone if needed (and document on the permit) Sign permit if no one is available after consult social worker to document the condition and start TPA
- 55. Neurologist In hours: Immediate evaluation including signing document and explanation Out of hours: Evaluate the patient with ambulance staff via mobile phone Point of care video neurological examination
- 56. ER nurse Check vital signs and body weight Set big IV line and 3tubes (vein) Prepare IV pump for TPA 0.9*BW (1cc=1mg, max 90mg) 1st min: rate: x cc *60, volume: x cc 1 hour: rate: y cc, volume: y cc
- 57. ER logistics Direct from ambulance stretch to CT bed IV, blood sampling, vital signs Body weight, quick (video) NE
- 58. Question Point of care INR and STAT CBC/PLT When to initiate IA thrombolytics? If <6 hours (Do MRI with MRA) If personnel available If basilar artery occlusion
- 59. Show Chwan model Beyond the NHI guidance A possible niche market
- 61. Attaining rapid stroke thrombolysis within 30 min Thrombolysis bundle initiative in Show Chwan health system
- 64. 10 月 7 日
- 66. 這次不一樣 ???? 又來了
- 67. 首波
- 68. 沒有品質 沒有核刪
- 69. 特點
- 70. 高給付額 團隊報名
- 71. 時間
- 72. 急性後期 下轉開始 6 到 12 週
- 73. 分級
- 74. 起始狀況 積極復健潛能
- 76. 潛能
- 77. 意願 體力 主動 家庭
- 78. 結案
- 80. 條件
- 81. 跨院際 整合團隊模式 提出申請
- 82. 復健人力物力 每 4 床至少需 1 位 物理 or 職能 or 語言治療人員 ( 治療師 or 治療生 )
- 84. 至少各 1 名 專任 護理人員 物理治療師 職能治療師 語言治療師 藥師 營養師 社工人員 ，
- 85. 專屬床位
- 86. 急性後期 照護單位
- 87. 個人專屬 急性後期照護計畫
- 89. FRG1
- 90. FRG2
- 91. 評估費用
- 92. 高強度
- 93. 可能策略
- 94. 自轉 PAC
- 95. 評估收入
- 98. 體系之外 彰基轉彰化彰濱 ( 彰化市、鹿港、芳苑、福興 ) 彰濱轉鹿基、二基 ( 二林、鹿港、芳苑、福興 )
- 102. 最後期限 11 月 8 日 完成版本 11 月 15 日 最後修 定
- 104. Independence
- 105. Acute stroke total solution service From thrombolysis to post-acute care Show Chwan health system