across the world · 2020. 6. 17. · wso angels platinum status awards wso angels diamond status...

ACROSS THE WORLD

SUMARYAlgeria..................................................................................................................................3Argentina..........................................................................................................................5Brazil......................................................................................................................................7Brunei..................................................................................................................................9Chile.....................................................................................................................................11Colombia.........................................................................................................................13Ecuador............................................................................................................................14Egypt..................................................................................................................................15India.....................................................................................................................................16Indonesia........................................................................................................................18Iran......................................................................................................................................20Jordan..............................................................................................................................21Kuwait..............................................................................................................................22Malaysa..........................................................................................................................24Mexico.............................................................................................................................26Peru...................................................................................................................................28Philippines....................................................................................................................29Saudi..................................................................................................................................31Singapura......................................................................................................................32South Africa................................................................................................................34South Korea................................................................................................................37Thailand..........................................................................................................................39Turkey...............................................................................................................................41Vietnam..........................................................................................................................44

Population

43.333.255 61.893 100

Estimated of strokes Stroke hospitals needed

Algeria ANGELS IN

New hospitals in RESQor other registry

Hospitals registeredin Angels

# of new centres becomingstroke ready ( from thoseenrolled into Angels initiative)

Average reduction

Average increase

# of centreswith registry

Door toCT time

Recanalisationprocedure rate

Door to treatment time

Patients in RESQor other registry

WSO angels gold status awards

WSO angels platinum status awards

WSO angels diamond status awards

2018

42

11

26

45 min45 min

65 min

0%

11

0

40

8

13

65 min

40%

1,4%0,8% 2,4%

80% 65%

8

10

3

5

-

120 min

-

-

4

26135

00

000

000

2019 2020 until February

3

Due to a strong digital plan in May 2020:

Algeria stroke digital plan first outcomes

• Several Algerian stroke centers returned to “ before Covid-19pandemic ” performance• 1 new stroke center opened

METAWebinar

COVID-CV Disease22th April

800 AttendeesNPS>75%

4

Population

40.276.376 56.350/year 123


ArgentinaANGELS IN




Average reduction

Average increase


Door toCT time







2018

13467 151

5334 61

3711 41

-- -

-13%- -13%

-- 24%

- --

37-

-

40

2.310 2.805

1 8 00 4 00 7 0


53 min61 min 46 min

5

Experience at San Bernardo HospitalSalta, Argentina

Background: Nursing course at the San Bernardo Hospital, in Salta. It reduced the door-needle time from 60

minutes to 20 minutes, after completion.

Description: The San Bernardo hospital is the most important public hospital in the city of Salta and has a

stroke patient care service. It has around 180 nurses.

The head of the service agreed to give the nursing Angels course in person and through the online platform.

In addition to the Angels certification, the Ministry of Health of Salta endorsed this course giving a score to

each assistant.

Outcome / Impact: The course was taught with all the material on the platform, dividing the 20 modules into

four courses. Nurses from the hospital itself and others HCPs from the interior of the province as well as from

private institutions participated.

6

Population Estimated of strokes Stroke hospitals needed

BrazilANGELS IN




Average reduction

Average increase


Door toCT time







2018 2019 2020 until February

304154 318

18232 194

7955 85

-

5629 61

1.770- 1.829

0 5 10 1 00 1 0

210M 191/100.000 800

30 min

58 min

29 min

55 min65 min

15% 11%

24%32%14%

18%.

15%

18% 10%

7

Key Highlight

Experience of the telestrokein a country side of Brazil

• Team formation• Training• Pre hospital protocol• Lauch and dissemination(radio, Newspapers and events)• Continuing education andcertification of professionals• Project of awareness tokindergarten• Accreditation by the Ministryof Health

Background: The city of Ituverava is a municipality in São Paulo and has 40,994 inhabitants and serves 5 cities in the district. The challenge was to provide care to this population that was not aware of the signs and symptoms of stroke, and did not arrive at the time of the therapeutic window.

Description : Telestroke has the support of 6 neurologists who are available 24 hours/7 days. We currently have 13 públic hospitals supported by telestroke through Allm and BI. EACH Neurologist can support up to 20 hospitals.

Outcome/Impact: Recanalisation procedure rate was 0% before telestroke and all activities carried out, average increase was 38%.

Project: Theaching children about stroke

8

Population

433.000 300 3


BruneiANGELS IN




Average reduction

Average increase


Door toCT time







2018

21 4

00 0

00 0

00 0

0%

00 0

0 0 00 0 00 0 0


20 min20 min22 min

45 min47,5 min50 min

5%9,1% 5,3%

8%7%

14,3%16,7%

8%

9

Beating the Clock for Stroke with SimulationsBrunei Darussalam/ Raja Isteri Pengiran Anak Saleha Hospital (RIPAS),

Brunei Neuroscience Stroke & Rehabilitation Centre (BNSRC)

Key Highlight

• Nation-wide simulationworkshops for stroke referral

• Improved in-hospitalworkflow for stroke referral

• Incorporation of ANGELSChecklists

Background: Brunei Darussalam has a unique referral system whereby emergency services are required to

send patients to general hospitals for a confirmed suspicion of stroke before being directed to the Brunei

Neuroscience Stroke & Rehabilitation Centre (BNSRC) for treatment. This would mean that pathways in both

the general hospitals and specialist centre have to be optimized to reduce door-to-needle treatment times for

patients.

Description: In 2019, the Emergency Department team from RIPAS together with the Angels team pioneered

a series of simulation workshops nation-wide as part of their efforts to improve in-hospital processes for

referral of eligible stroke patients to BNSRC.

Recognising that there are various teams involved in this chain of process, the team reached out to paramedi-

cs from the Emergency Medical Ambulance Services (EMAS), the ED Nursing personnel and the team of neu-

rologists from BNSRC to seek their participation and involvement in the workshops, which would allow for

simulation of a real-life stroke activation.

Outcome / Impact: A standardized in-hospital workflow for stroke which includes use of Angels checklists

were established. These checklists were trialed in the simulations and subsequently introduced to all hospi-

tals. As a result of these simulations, improved workflows and usage of checklists, each workshop saw an

improvement in the DIDO time.

10


ChileANGELS IN




Average reduction

Average increase


Door toCT time








5424 73

2315 39

115 12

-- -

17,7%- 12,7%

12,2%16% 11,2%

-23,8%- -8,2%

115 12

1.100200 1.800

0 7 01 0 00 0 0

18.828.525 24.477 47

44,5 min51 min62 min

11

Stroke in Clínica DávilaChile

Background: STROKE is a frequent cause of hospitalization in Davila Clinic. In our clinic, we decided at the beginning of 2019 to review our thrombolysis times, with the aim of recognizing

the strengths and weaknesses of our care for acute ischemic stroke. When analyzing these times, we realized

that, despite offering good care, there were aspects to improve, such as, for example, DTN, evaluation times

in Triage, evaluation by the neurologist, obtaining neuroimaging and start of treatment.

Description: Once the problems were identified, together with the Angels initiative, we designed a work plan that would allow all the personnel in our emergency service to be trained in all areas of the acute phase.

In addition to the days of intense training, the creation of the STROKE code, called the Yellow Key, was gene-

rated, which is activated at the moment the emergency doctor receives the patient who was prioritized in

triage. This key is heard throughout the clinic, which means that all the services involved are attentive to the

patient's movement.

In addition to the days of intense training, the creation of the STROKE code, called the Yellow Key, was gene-

rated, which is activated at the moment the emergency doctor receives the patient who was prioritized in

triage. This key is heard throughout the clinic, which means that all the services involved are attentive to the

patient's movement.

The yellow code started operating in May 2019 and we decided to analyze thrombolysis times in

December of the same year, where we found that with an intensive intervention of one month, which

included training and generating team motivation, thrombolysis times were reduced by 30% and the

percentage of patients with thrombolized strokes reached almost 20% of the total they consulted. Our

DTN was on average 41 minutes, significantly less than before the intervention.

Outcome / Impact: In summary, improving IV thrombolysis times requires education, motivation and organi-zation of all emergency-related personnel, for a rapid diagnosis and treatment of the patient with stroke. No

extra economic costs were incurred to generate the improvement, we just took on a challenge with determi-

nation, and together with the Angels initiative, we hope to continue improving in our fight against LCA.

Neurovascular equipment Dávila Clinic

Equipo Neurovascular

Clínica Dávila

12

Population

50.374.478 65.991 132


ColombiaANGELS IN




Average reduction

Average increase


Door toCT time







2018

67 75 77

32 52 52

27 52 55

-

-

- -

25 327

3.619 4.795358

2 8 00 1 00 0 0


57,21 min58,36 min61,3 min

-5%

-

-2%

15%9% 15,17%.

67% 1%

13


EcuadorANGELS IN




Average reduction

Average increase


Door toCT time








7631 77

10- -

4- -

-- -

- -

-- -

15%- -

-- -

-- -

52- -

0 0 00 0 00 0 0

17.319.790 64

48 min

14

Population

104.000.000 500


Egypt ANGELS IN




Average reduction

Average increase


Door toCT time







2018

19

36

16

-

-

-

13

0

19

34

14

-

-

-

12

5

20

10

-

-

-

-

1.8201.760-

03

003

000


20 min30 min

100 min110 min

-

-

15

Population

137.8M 165.348 1.160


IndiaANGELS IN




Average reduction

Average increase


Door toCT time







2018

165 241 252

11 140 144

0 84 87

25 min 18 min21 min

61 min 54 min70 min

9% 7%

11% 11%10%

1%

-

0% -

85 30

2.300 2.704-

0 0 10 1 10 2 2


16

The Success Story Behind T.D Medical College Hospital Alappuzha, Kerala

Background: T.D. Medical College Hospital is situated in Vandanam town in Alappuzha district of Kerala State, South India. Our medical college was started in 1963 under the patronage of the T.D, Thirumala Devaswom Temple at Alappuzha. In 2010 shifting of the Medical College Hospital from Alappuzha to Vandanam has been completed as a red-letter day in the history of our Medical College Hospital with the help of State Government. The college and hospital are situated in a campus having an area of 162 acres and there is enough space for all types of future developments and developing this college and hospital as a Centre of Excellence in various fields of Modern Medicine. The whole hospital departments are occupying a floor area of about 28,000 sq. meter and it is situated in an area of around 60 acres of land.

The department of Neurology has conducted various community-oriented programs such as Stroke awareness programs for the public and faculties, Medical camp for cerebral palsy patients. We have good infrastructure facilities and major types of equipment and a well-established dedicated Stroke ICU. The Neurology department in stroke medicine offers Inpatient care, 24-hour neurology casualty care, round the clock emergency stroke Thrombolysis, stroke ICU Management, Trans Cranial Doppler study of stroke patients.

Description: Since Mar 2018, in association with Angels Initiative, we have conducted First & second Simulations in May 2018 & Jan 2019 respectively. We enrolled for Angel's academy Stroke Nurse E-learnings, Body Interact virtual training, and a few multidisciplinary standup meetings for our doctors, nurses, paramedic staff. Angels supported us in the stan-dardization of our stroke pathway. The focus of these departmental training sessions was to coordinate all the members who are helping in stroke care. This comprises of the emergency medical team to Stroke rehabilitation therapists which attracted significant interest from all. We recently organized a Faculty Improvement Program (FIP) and Community-ba-sed stroke awareness events. As time is the brain, we significantly optimized and improved our stroke treatment time with good clinical outcomes, with Support of Stroke helpline (EMS), good imaging services, dedicated stroke unit & also Angels initiative.

Outcome / Impact: The Department of Neurology admits more than 800 patients with Stroke annually. In the past 2 years, the following are some of the highlights of our achievement:

· From Mar 2018 to Mar 2020: The average thrombolysis rate increased from 10% to 18.75%. · From 2018 to 2020: Average Door-To-Treatment (DTT) time has been significantly reduced from 75 minutes to 55 minutes. DTT is 45 min. for more than 25% of ischemic stroke patients, well below the recommended 60 minutes. · From 2018 to 2020: Average Door-To-CT/MRI time was reduced to less than 30 minutes in 2020, an improvement of 25%. · Our hospital achieved Stroke ready Status in all quarters as per RES-Q since its being enrolled with the RES-Q registry in February 2019.

After a simulation at TD Medical College hospital, Dept. Of Neurology, 2019.

17

Population

271.000.000 200.000 435


IndonesiaANGELS IN




Average reduction

Average increase


Door toCT time







2018

12080 160

3822 46

82 8

--

-

-

-

3,3%2,8% 3,5%

18% 6%

258 36

1.035118 1.500

0 2 20 1 10 0 0


67 min71 min90 min

21% 6%

18

TOWARDS INDONESIA STROKE READY:REFERRAL HOSPITALS ACTIVATION

Key Highlight

• The effective stroke system in the country depends on the commitments from government and stroke organizations

• National stroke guideline is needed to standardize stroke care management in the country

• Government involvement is needed to ensure the success

Background: To cover the population, definitely Indonesia needs more than 400 ASR, while in 2019 we only have less than 50. Top down approach is needed to accelerate the process. The idea is to get referral hospitals stroke-ready first, then expecting others to follow. Since those are government referral hospitals under MoH which are role models to others.

Description: It is the efforts of collaboration between ANGELS and Market Access team and also with NBC (National Brain Center) which working on the same expectation towards Indonesia Stroke Ready. Involving MoH to invite and ensure targeted participants (director, neurologist, ER head) from referral hospitals to join the meeting. Supported by ROPU for inviting stroke expert – Prof. Robert Mikulik from Czech Republic to share about the effective stroke care system which depend on commitments from government and stroke organizations.

Meeting Objectives:

· To increase awareness of the importance of having standardized stroke center in all national & province referral hospitals · Trigger to start the standardizing /improving in-hospital stroke care process/pathway · Encourage and urge MoH to create new stroke care policies include local guideline standardization & implementation

Outcome / Impact:

· Better understanding to MoH and all participants on what’s currently happening in Indonesia on stroke care management and all concerns/challenges that coming from the participated hospitals in managing stroke patients in hospital level includes the need and expectation on new stroke policies in the country from MoH · Acceleration of national stroke guideline approval by MoH · 40% growth of number thrombolysis and 28% growth of TR in government hospitals (2019 vs 2018)

19

Population

83.625.634

418


IranANGELS IN




Average reduction

Average increase


Door toCT time







2018

91

57

18

35 min

60 min

7%

6,5%

0,1%

18

1.750

87

54

40 min

65 min

4%

6,4%

83

45 min

68 min

6,1%


- 0,3%

--

--

0 0 00 0 00 1 0

-

--

-

20

Population

9.700.000 25.000 20


JordanANGELS IN




Average reduction

Average increase


Door toCT time







2018

5

4

8

100%

-

100%

8

0

5

2

8

0

0

0

0

0

8

0

1

0

0

0

0

0

0

0

300

00

000

000


10 min

41 min

21

Population

14.143.256 34


KUWAIT ANGELS IN




Average reduction

Average increase


Door toCT time







2018

15

12

10

-

14,90%

-

5

0

13

10

9

-

7,80%

-

3

4

2

0

-

-

-

-

-

0

750650-

00

510

000


30 min

43 min

35 min

55 min

22

“Optimizing Stroke Pathways in Covid-19 Pandemic”

GulfIP Angels Virtual SteeringCommittee - 16 May 2020

Objective: Gain insights from country experts on how to maintain a reasonable TR and DTN considering that the current pandemic has had a direct impact on stroke care and prioritization as an emergency.

• Engagement of 7 top tier regional & international experts and country leads to lead the project – highly and positively received by all experts

• Sharing best practices and challenging cases with regards to how current situation has impacted stroke care in respective countries

• Localized amendments on current stroke protocols to best fit with the current pandemic with the support of Angels team

• To create a consensus manuscript from gained insights and experiences for publication in a reputable journal to serve asreference and guide for all countries treating stroke and being impacted by the COVID-19 crisis

Advisor

Dr. Suhail Al Rukn

Dr. Waqar Qaba

Dr. Masoud Mehrpour

Dr. Babak Zamani

UAE

UAE

Iran

Iran

Country Advisor Country

Dr. Amal Al Hashmi

Dr. Naveed Akhtar

Prof. Ashfaq Shuaib

Oman

Qatar

Canada

23

Population

32.869.300 41.415 92


MalaysiaANGELS IN




Average reduction

Average increase


Door toCT time







2018

6336 64

92 11

97 12

22%- 9%

4,20%3,99% 5%

0,21%- 0,80%

62 7

7434 1.174

0 3 30 0 00 1 1


30 min

64 min

33 min

70 min

50 min

90 min

24

MYStroke Hospital Web LocatorKey Highlight

• Collaboration with Stroke Associations

• Budget

• Timeline to launch

Background: There is unmet need that public unaware where to get treatment if they

get a stroke. This causes a lot of patients not able to get their treatment in time.

Description: We collaborated with Malaysia Stroke Council and NASAM to create

this website, which allows the public to locate the nearest stroke hospitals.

We started off by engaging a local media agency to develop the website and we

manage to launch it in less than 3 months time. Available in both English and Bahasa

Malaysia, the website features an interactive map where users can indicate their

current location to find the nearest private and public hospitals that can provide acute

stroke treatment. Meanwhile, users can also access important information about

stroke. In conjunction with World Stroke Day, we also leverage Grab Advertisement to

generate call-to-action to this Web Locator.

Outcome / Impact: We have accumulated > 18,000 views on this page as of YTD Feb.

We believe this website will definitely generate long term benefits to the public as

they are now able to locate a stroke ready hospital much more readily. This year we

will conducting more outreach activities to ensure that the knowledge of this website

is further disseminated.

25


MexicoANGELS IN




Average reduction

Average increase


Door toCT time








237172 255

16649 175

810 92

50%- 9%

10%1% 11%

9%1% 1%

810 92

8008 1.000

0 1 00 1 00 0 0

129.000.000 36.984 599

60 min 50 min

25 min30 min60 min

120 min

26

The first step of national standardizationof stroke care: RESISSSTE Cerebro

Key Highlight

• Since the national guideline

from 2008, advances in stroke

care in Mexico have not been

significant.

• This is the first nationwide

effort from 1 of the 3 major

institutions in Mexico to stan

dardize stroke care.

• ANGELS has been involved as

a training support since the

beginning of the program.

Background: Since the last national stroke guideline in 2008, stroke care advances in Mexico haven’t been significant. Medical care in Mexico is divided by institutions, rather than by a unique institution. This makes difficult to standardize patient care within all the institutions. The main institutions in Mexico are IMSS, ISSSTE and SSA. The 3 of them had made in recent years myocardial infarction care as a priority, imple-menting protocols and timely care. In 2019, for the first time, ISSSTE deployed the strategy RESISSSTE Cerebro, a nationwide stroke system of care.

Description: RESISSSTE Cerebro was developed initially as a network consisting of a primary stroke center and 4 stroke ready hospitals with ANGELS supporting on the training area of the program. The hospital network reduced door to treatment time, disability urging the need to implement it nationwide. The goal is to progressively include more hospitals starting 2109 in 3 major cities, and for 2020 growing to 15 so in time every major city will have adequate stroke care.

Outcome / Impact: In 2010, the successful implementation by IMSS of the myocar-dial infarction program, urged the other major institutions to also implement nationwi-de equivalent programs to guarantee patient care. RESISSSTE Cerebro represents the first step towards the national standardization of stroke care in Mexico.

27


PeruANGELS IN




Average reduction

Average increase


Door toCT time








7631 82

10- 10

16- 16

-- -

59 min- 53 min

-- -

15%- 11%

-- -

-- -

118- -

0 0 00 0 00 0 0

31.914.989 20.553 64

28

Population

109.703.400 365164.555


PhilippinesANGELS IN




Average reduction

Average increase


Door toCT time







2018

109 90

12 -

39

-

-

-

-

-

-

-

0

-

-

-

-

-

-

39

2,50% 2,84% 4,08%

0,34% 0,88%

11 6

-1.005377

0 1 00 1 00 0 0


29

The Success Story Behind Baguio General HospitalPHILIPPINES / BAGUIO GENERAL HOSPITAL DEPARTMENT OF NEUROLOGY & ANGELS

Key Highlight

• The ANGELS Initiative partnered with Baguio

General Hospital to pursue a common goal of

optimizing stroke care. The partnership focused

on the development of programmes with the

goal of enhancing the expertise and confidence

of doctors and nurses administering rTPA.

• Improvements in thrombolysis rate, DTN,

DT-Imaging, and mRS upon discharge were

noted over the past 3 years. In 2019, BGH was

awarded with the WSO Angels Awards for 2

consecutive quarters (Gold Status in Q2 and

Platinum Status in Q3).

• Optimizing stroke care remains challenging,

and Baguio General Hospital’s Neurology

Department continues to strive to reduce

disability among stroke survivors by providing an

improved standard of care in the region.

Background: Baguio General Hospital and Medical Center (BGHMC), also known as Baguio General Hospital (BGH), started as a 4-bed sanitarium to house soldiers recovering from the war in 1904. Since then, the hospital has flourished into a premier institution north of Metro Manila, with a capacity of 800 beds. In the mid 80s, the hospital’s Department of Neurology was a section of its Department of Medicine, where they shared a 30-bed allocation. On 29 October 2007, the Department of

Neurology officially opened its doors, with 6 beds allocated to stroke patients. This was the first facility dedicated to stroke patients that was recognized by the Stroke Society of the Philippines in a government institution north of Manila, where resources were scarce.

Because of its existing Stroke Unit and Neurology Training Program, the Department of Neurology was one of 22 hospitals to be chosen for the Stroke Medicine Access Program by the Department of Health in May 2016. The program provided rTPA to be administered to stroke patients who were suitable candidates for thrombolysis.

Description: Since May 2016, Boehringer Ingelheim, through the Angels Initiative, has helped to develop programmes with the goal of enhancing the expertise and confidence of doctors and nurses administering rTPA. With the ANGELS Initiative, the BGH stroke team was able to participate in simulation activities, in Nurses’ Stroke lectures, in the Doctors’ ASPECTs lecture, and the Stroke Masterclass.

The Angels Initiative has given Baguio General Hospital’s Neurology Department wings to soar in stroke care delivery. The partnership with Boehringer Ingelheim, through the Angels Initiative, has helped Baguio General Hospital’s Department of Neurology save countless lives and improve the outcomes of many stroke patients.

Outcome / Impact: The Department of Neurology admits more than 600 patients with cerebral infarction annually. In the past 3 years, the following are some of the highlights of BGH achievement:

· From May 2016 to May 2019: Thrombolysis rate increased from 3.99% to 11.96%. · From 2016 to 2019: Average Door-To-Needle (DTN) time has been significantly reduced from 73.08 minutes to 42.2 minutes, well below the recommended 60 minutes. · From 2016 to 2019: Door-To-Neuroimaging time was reduced to less than 20 minutes in 2016, an improvement of 48% from previous years. In 2019, this improved significantly to 92%. · 55% of patients had a modified Rankin scale (mRs) score of 0-2 upon discharge, significantly better than the NINDS Trial outcome of 30% and the Philippine cohort outcome of 51.1%. Having achieved these milestones over the years, the hospital achieved ‘Gold Status’ in the World Stroke Organisation (WSO) Angels Awards in Q2 2019. This was followed by a ‘Platinum Status’ achieved in the WSO Angels Awards in Q3 within the same year.

BGH Team receives the award during the APSC Convention in Manila last October 2019

30

Population

33M


SaudiANGELS IN




Average reduction

Average increase


Door toCT time







2018

60

25

9

45 min

75 min

0

8,7%

0

15

2

60

25

9

45 min

75 min

0

8,7%

0

9

National patients data is not disclosed

0

0

0

0

0

0

0

0

0

0

00

200

000


31

Population

5.850.342 8.000 4


SingapuraANGELS IN




Average reduction

Average increase


Door toCT time







2018

54 4

00 0

00 0

-- -

00 0

00 0

00 0

00 0

Launch of FAST Heroes 995 ProgrammeSG / Singapore National Stroke Association

Key Highlight

• ANGELS Partnership with a

Stroke National Support

Group in Singapore

• Launch of Pilot of FAST

Heroes 995 Programme

Background: In Singapore, many stroke patients do not arrive to the hospital early

enough to receive treatment. Currently, there are about 8000 stroke cases on

average a year with the figure projected to rise with a rapidly ageing population. There

is thus an urgent need to strengthen public recognition of the signs of stroke using

FAST, highlight that stroke is a medical emergency and emphasise that timely action

is key to preventing serious complications.

Description: In October 2019, the ANGELS team has partnered with the Singapore

National Stroke Association which is the national support group for stroke survivors

and caregivers to launch the pilot of a FAST Heroes 995 programme.

This programme is aimed at educating children and their families to be able to

recognize the three main stroke symptoms and to call 995 in the event that a stroke

is suspected. The program aims to kick-off in 2020 in selected schools in Singapore.

Outcome / Impact: This will be the first time that a stroke awareness campaign

targeted at children will be done in Singapore. By engaging children and their families,

the programme aims to broaden community awareness of stroke and FAST in

Singapore.

33

Population

58 M 141.520 283


South AfricaANGELS IN




Average reduction

Average increase


Door toCT time







2018

70

41

60

60 min

-

-

-

45 min

7%

29

90

66

60

45 min

25%

2%

-

30 min

9%

65

135

89

80

45 min

0%

4%

-

30 min

10%

87

000

000

000


34

1. Follow-up from Medical Village Best Practice Sharing – Melomed Gatesville:

Best Practice Sharing – South Africa

• At medical village, we shared the story of Melomd Gatesville Hospital and their improvements in patient care which resulted in a DTNT of 17min. To highlight the success of improved patient care at hospitals we developed a certificate of acknowledgement: For Striving Towards Excellence in Stroke Care and for Giving Life a Chance. This certificate was presented by Angels to the stroke team at Melomed Gatesville, the hospital group recorded the ceremony as well as interviewed the patient and the Neurologist to reiterate the importance of acting fast. Melomed used this video to promote their stroke services though various platforms with-in the community and intern inspired other hospitals to work with Angels to improve their level of stroke care. The video was submitted onto the Global Angels Website and can be viewed on the Angels community page.

3. Best Practice sharing during Covid Lock-down:

• In South Africa our stroke hospitals reported a reduction in the number of stroke patients presenting to these facilities. This correlates with the global trend seen in stroke hospitals across the world. To reduce the stigma associated with going to the hospitals we decided to do a media together with the Neurological Association of South Africa (NASA) and Heart and Stroke Foundation of South Africa (HSFSA). The media release encouraged patients not to be afraid during the time of Covid and to go to the hospital should they experience any symptoms associated with a stroke, it also emphasised the signs of a stroke through the BE FAST acronym The media release resulted in an interview (11th May), on a major South African news channels (eNCA), with one of our Stroke Neurologists. eNCA has a viewership of 1.7 million and the video was shared by the channel on various social media platforms, which resulted in 24k views. NASA and HSFSA are hoping this campaign will encourage stroke patients to seek medical care so that they can be adequately treated.

2. Best Practice Sharing for 2020 (Pre-Covid Lockdown):

• Situational Simulations workshops were organized for the casualty and internal medicine interns, registrars and consultants who run the emergency departments in our state hospitals. The situational simulation scenario was created based on how a typical stroke patient present at the respective hospitals. A stroke team from the audience was identified and the respective role players had to wear bibs (paramedic, patient, emergency Dr, neurologist, radiologist and pathologist) so that the audience could evaluate their performance accordingly. After the simulation we had a debrief with the treating stroke team and audience on their performance and what strategies could be implemented to minimize delays. These strategies were then implemented into casualty departments at the respective state facilities to reduced current delays in stroke care. These simulations resulted in a reduction in DTNT from > 2hrs to 1hr at some hospitals and improved transfer of patients from outlying acute stroke hospitals to comprehensive stroke hospitals for further care.

35

Video Uploaded onto the Angels Website: Situational Simulations:

Media Campaign to urge stroke patients to seek medical attention during Covid:

Video link: https://vimeo.com/415441448/25b1ea20cc

Video link: https://www.youtube.com/watch?v=fZEEBzqr9UA

36

Population

5.178.579 109.145 230


South KoreaANGELS IN




Average reduction

Average increase


Door toCT time







2018

43 121 125

7 16 21

60 67 76

12 min 12 min15 min

51 min 50 min60 min

15%- 2%

8,1% 8,1%6,5%

21% 21%

18 18

264

-

0

0 730

0 0 10 1 20 1 2


37

RES-Q: Make the impossible possible

Key Highlight

• Agility

• Passion

• Collaboration

• Intrapreneurship

Background: To improve stroke care, having a quality monitoring culture is important. RES-Q (Registry of Stroke Care Quality) is global registry designed for easy monito-ring and analysis of stroke care quality. Since the launch of Angels Initiative in Korea in 2017, the Angels team has been encouraging hospitals to be part of this registry for same purpose. However, KSS (Korea Stroke Society) did not see the value of Res-Q due to availability of local registries led by the academic society, hospitals or govern-ment, although not all stroke hospitals are involved in these local registries.

Description: Due to efforts by Angels consultants, 18 sites were registered on RES-Q as of Apr 2020, a significant step towards furthering the quality culture in Korea. Of these, the Chonnam National University Hospital (Q2 2019) and the Gyeongsang Na-tional University Hospital (Q3,Q4 2019) were the first hospitals in the country to be recognized with WSO Angels Platinum and Diamond status respectively, and will con-tinue in their efforts to optimize their quality.Dong-A University Hospital, Chonbuk National University Hospital, and Daejeon Yuse-ong Seon Hospital are expected to qualify for awards in near future, and Chonnam Na-tional University Hospital is now vying for the Diamond level.

Outcome / Impact: The data submitted from Korea in RES-Q will be analysed and published as part of a retrospective study on quality improvement using the RES-Q registry.

The awards also acknowledge the achievement of the centers and individuals who are committed to quality improvement in stroke practice.

38

Population

69.306.200 81.088 180


ThailandANGELS IN




Average reduction

Average increase


Door toCT time







2018

174-

--

174

7

0

-

28 50

15 min

43 min-

-

-

-

-

-

0

0

10,7%

25

6.143

15 min

47,22 min

-

-

15%

-

-

0 16 00 6 00 2 0


39

Thailand ANGELs simulation Key Highlight

• Beneficial

• Improve quality

• Easy to do

Background: ANGELs simulation is one of the most efficient tools to optimize stroke pathways, through simulating situations of acute stroke patients care in the hospital, and

identifying areas that will allow reduction of door-to-needle (DTN). It involves video recording

of the full stroke pathway, from arrival of patient up to treatment and observation in stroke

unit.

Description: During the simulation briefing, ANGELs Thailand presents the benefit that hos-pitals will receive when they conduct the simulation and the simulation process. In Srinaga-

rind hospital, the briefing was held with Neurologist and Emergency physician. The simula-

tion video recorded the full process, including the process in pharmacy unit (how rt-PA was

ordered), laboratory unit (the process to order blood tests) – the detailed record of every step

in every process enabled the stroke team to have full visibility of the possible time delays

that could be avoided, and hence reduce DTN and increase thrombolytic rate effectively.

Outcome / Impact: After Srinagarind hospital’s first simulation, the team identified a lot of gaps for improvement. The stroke team implemented several steps to improve DTN, for

example removing chest X-ray and revising the stroke protocol. As a result, Srinagarind

improved their DTN from 45 to 35 mins. The neurologist and stroke team was appreciative

and wishes to conduct ANGELs simulation again soon. The Neurologist from Srinagarind is

also now an advocate for simulations and shares his ANGELs simulation experience in mee-

tings as a speaker; he believes ANGELs simulation that can improve stroke system.

40

Population

82.003.882

215/100.000 200


Turkey ANGELS IN




Average reduction

Average increase


Door toCT time







2018

64

4

18

0

90 min

0

11%

0

10

720

100

-

-

-

-

-

-

-

-

-

-

000

-

-

-

-

-

-

-

-

-

-

000


41

Main topics are indicated below:

Turkey-Directive on Healthcare ServicesFor Acute Stroke Patients

• General Conditions• Characteristics of the Units• Neurointerventional Procedures • Referral Rules• Keeping of the Records • Following and Evaluation• Forming of the Commissions, • Manner of Application and Registration

In July 2019 Turkish Ministry of Health published Directive on Healthcare Services For Acute Stroke Patients. According to that guideline, the procedures and principals for acute stroke are determined and these topics are detailed accordingly.This guideline matches up with Angels’ goals completely thus the number of stroke centers will increase gradually.

42

Population

97.216.000 158.000 350


VietnamANGELS IN




Average reduction

Average increase


Door toCT time







2018

54 101 103

22 58 59

3 13 14

30 min 30 min37 min

55 min 49 min60 min

8,3% 10,9%

7,51% 6,44%6,4%

17,3%

-

- 4%

3 08

25.573 33.27311.775

0 8 00 1 00 0 0


43

ANGELS WEBINARSKey Highlight

3 key takeaways:

• Time-saving

• Cost-saving

• Continue learning

Background: 70% of hospitals which are undergoing Angels consultation are in provinces which are challenging to visit frequently due to geographic accessibility. During face-to-face consultancy visits, Angels team focuses on conducting activities such as in-hospital simulation, and explore other virtual tools to conduct case discussions and training.

Description: Since September 2019, ANGELS Vietnam team implemented 5 ANGELS webinars targeted at provincial hospitals:

· 1 for quality monitoring improvement · 3 sessions for stroke teams to share challenging stroke cases, to improve decision making and treatment confidence · 1 targeted at stroke nurses on topic of stroke management in Emergency Department (Hyper -acute phase) and Neurology Department (Post-acute phase)

Outcome / Impact:

· Webinars have allowed time and resource savings for stroke teams, allowing them to continue learning no matter where they are · After the quality monitoring webinar, there was also an increase in 4 hospitals participating in Res-Q, as well as 2 hospitals who now apply the Helsinki model · At the end of 2019, Vietnam had 52 hospitals which have implemented priority action of treating patients directly at CT, reducing the average DTN by 5 minutes

44

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across the world · 2020. 6. 17. · wso angels platinum status awards wso angels diamond status...

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