SGH team looks to F1 pit stop model to improve outcome for stroke patients.
In Formula 1 (F1) motorcar racing, pit stops are one of the most intense features. Races are frequently won and lost because of the pit stops and the crew, as a stop of a few seconds can give the competition a lead of a few hundred metres.
Similarly, time is of the essence in treating stroke when the patient arrives at the Emergency Department - everything needs to happen at the same time.
Adopting a model like the F1 pit stop,
Singapore General Hospital has successfully cut the time taken for an acute
ischemic stroke patient to undergo a thrombectomy from around 130 minutes to an average of 80 minutes.
”Stroke treatment is like an F1 pit crew model of parallel processing, where anything that can be prepared ahead is done so, and every member of the team knows their role perfectly and is ready to jump in,” said
Dr Chia Ghim Song, Senior Consultant, SGH Neuroradiology.
He is a lead in a multi-disciplinary team that worked on a quality improvement project that was two years in the making - Reducing Door-to-Puncture Time for Endovascular Thrombectomy in Stroke. The team was able to compress the multi-step process through careful planning and preparation and allowing tasks to be done simultaneously.
(From left) Tan Xiong Wei Nelson, Wong Wang Hong Terence, Chew Jing Si, Dr Chia Ghim Song, Dr Liu Zheng Hong, Dr Rachel Leong Wei Li, Yeo Su Qian, Dr Pang Yee Hau
What causes a stroke?
Stroke can be due to blockage in a blood vessel (ischaemic) or bleeding from a burst blood vessel in the brain (haemorrhagic). Of the two, ischaemic stroke patients make up about 80 per cent of people who suffer stroke yearly. Of this group, 10 to 20 per cent have the most devastating type of blockage affecting large blood vessels.
How is stroke treated at SGH?
Minimally invasive endovascular mechanical thrombectomy is a commonly used treatment for acute ischaemic stroke that removes blood clots in the brain to restore blood flow. Blockage to blood flow in the brain can cause severe damage.
“We achieve better functional outcomes for patients when the blood clot is removed and blood flow is restored quickly. For every 60-minute delay, patients have a 15 to 20 per cent worse functional outcome at 90 days,” said
Dr Pang Yee Hau, Senior Consultant,
Neurology (SGH Campus), National Neuroscience Institute (NNI). Dr Pang co-led the project with Dr Chia.
A team from Emergency Medicine, Neurology, Neuroradiology, Diagnostic Radiology, Radiography, Anaesthesiology – all involved in treating stroke patients -- and Process Transformation and Improvement Unit examined how processes during the patient journey can be done quicker through streamlining, standardisation and protocols.
“For instance, before, we would do a regular CT (computed tomography) scan, and then discuss if a CT angiogram should be done after. Now, we proceed to do both scans for stroke patients who meet a standardised criteria. Communication and documentation are also standardised so that pertinent information is transmitted clearly and efficiently,” said Dr Chia.
To cut time down further, the team prepared kits like the Tissue Plasminogen Activator or TPA box containing equipment and other necessities used for dissolving blood clots. “So there is no need to look for individual items when needed,” said Dr Chia.
A secure Microsoft TEAMS chat group application that included everyone involved was used to rapidly activate and coordinate the team, and to also coordinate patient medical details and transfer between locations in the hospital and the angiosuite, where thrombectomy was done.
“When the new SGH Emergency/ NNI building is fully operational, the team would have an additional dedicated stroke angiosuite, which would increase our current capacity and potentially save precious time,” says Dr Chia.
The team started the project in 2021. “It was challenging to reduce the time taken, but the team strived on for almost two years, and significantly reduced the time taken by 37 per cent. We shared the changes with other hospitals in Singapore where thrombectomy is done, to spread the improvements beyond our hospital,” said Ms Yeo Su Qian, Assistant Director, Process Transformation and Improvement, SGH.
The project won the 2024 National Healthcare Innovation Productivity (NHIP) award in the Best Practice Medal (Care Redesign) category.
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