10th Anniversary of Asia Pacific Stroke Organization: State of Stroke Care and Stroke Research in the Asia Pacific

The Asia Pacific Stroke Organization is the largest international and professional stroke group in the region. It has worked consistently over the last 10 years to gain visibility and reliability across the Asia Pacific and beyond. The 10 year journey will be reviewed in the background of many internal and external developments including changes in Asia Pacific stroke epidemiology, stroke care systems, stroke service developments as well as major research studies in the Asia Pacific.

GIS Mapping Evaluation of Stroke Service Areas in Bangkok Using Emergency Medical Services

Stroke is a major cause of death in Thailand. It requires a specific time period of 4.5 h from onset to treatment to increase recovery rates, and therefore, it can be categorized as a time-sensitive disease. The objective of this research is to identify whether the service areas of the main existing Emergency Medical Services (EMS) prehospital stroke practices cover all areas in Bangkok. This is determined by using GIS mapping. After verifying the current EMS delivery models, comparisons are drawn to find the travelling time of each model. The conditioning factors for GIS mapping were collected and verified, including the traffic speed and duration spent in each mode of the prehospital stroke process. After inputting all of the data into GIS, the service areas were visualized to show the area serviced in each delivery model. The results also show the different hospital groups, including the service areas for (1) non-network hospitals and (2) hospitals with stroke networks. Suggestions for re-networking and adding more hospitals to the existing networks were also identified using GIS. Regularly updating the service area with up-to-date data in GIS is key to improving stroke service areas.

Efficacy and safety of bridging thrombolysis initiated before transfer in a drip-and-ship stroke service

ObjectiveData regarding the efficacy and safety of bridging thrombolysis (BT) initiated before transfer for evaluation of endovascular therapy is heterogeneous. We, therefore, analyse efficacy and safety of BT in patients treated within a drip-and-ship stroke service.MethodsConsecutive adult patients suffering from acute ischaemic stroke and large-vessel occlusions (LVO) transferred to our comprehensive stroke centre for evaluation of endovascular therapy in 2017–2020 were identified from a local prospective stroke database and categorised according to BT and no-BT. BT was defined as intravenous thrombolysis initiated before transfer. LVO was assessed before and after transfer. Functional outcome before stroke and at 3 months using the modified Rankin scale (mRS) was determined. Excellent outcome was defined as mRS 0–1 or return to prestroke mRS. For safety analysis, intracranial haemorrhages and mortality at 3 months were analysed. Main analysis was limited to patients with anterior circulation stroke.ResultsOf N=714 patients, n=394 (55.2%) received BT. More patients in the BT group with documented LVO before transfer recanalised without endovascular therapy (n=46, 11.7%) than patients who did not receive BT before transfer (n=4, 1.3%, p<0.001). In multivariate analysis, BT was the strongest independent predictor of early recanalisation (adjusted OR 10.9, 95% CI 3.8 to 31.1, p<0.001). BT tended to be an independent predictor of an excellent outcome at 3 months (adjusted OR 1.38, 95% CI 0.97 to 1.96, p=0.077). There were no differences in safety between the BT and no-BT groups.ConclusionsBT initiated before transfer was a strong independent predictor of early recanalisation.

Abstract P185: Feasibility and Outcome of Pharmacist-Enhanced Stroke Rounds

Background: Treatment of stroke patients is complex. Multidisicplinary rounds have been shown to decrease 30-day readmission rates, improve efficiency in work flow, communication between disciplines and promote patient-centered care. Pharmacy-enhanced intensive care unit rounds reduce adverse drug events (ADE) and provide real-time resource for drug selection, interaction and dosages. Reports on the feasibility of pharmacist-enhanced stroke rounds (PEnSR) and its effect on outcomes are few. Objective: Determine the effect of a pharmacy-enhanced stroke-rounds on patient and healthcare outcomes. Methods: A performance improvement analysis was done in the University of Mississippi Medical Center from September 1, 2019 to November 30, 2019. A pharmacist assigned to the stroke service performed medical reconciliation, monitored drug interaction, provided recommendations on drug choice and dosages for the stroke patients and alerts on medication errors. The primary outcome includes the proportion and severity of medication errors detected utilizing the EPIC iVent tool. The secondary outcomes include characteristics of interventions to prevent an ADE, cost-avoidance based on the errors and cost-analysis for the continued presence of a pharmacist for stroke rounds based on time spent to perform the role. A feedback-survey regarding the pharmacist was done at the end of analysis period. Results: A total of 77 interventions were performed during 2 month with a total cost avoidance of $40,250. Most common errors were minor. The most common intervention by the pharmacist was to initiate orders followed by discontinuing orders. Overall time spent daily for the stroke service was 5-hours. All residents and attendings of the stroke service were aware of the pharmacist’s presence, utilized the service and perceived that the PEnSR was beneficial. Conclusion: PEnSR was feasible and cost-effective and allows for the pharmacist to still contribute to other roles in the hospital. PEnSR also improves patient-centered care for stroke patients by preventing ADE resulting in hospital savings of ~$20,000/month. The UMMC-Stroke team has adapted PEnSR as part of the daily multidisciplinary stroke care.