Stroke is a common neurological condition and the most common cause of disability among adults in Singapore. Optimal outcomes are dependent not only on facilities and skilled staff, but on a multidisciplinary approach for its management. The dedicated multidisciplinary team at NUH includes neurologists, interventional neuroradiologists, emergency physicians, neurosurgeons, radiologists, rehabilitation physicians, anesthetists, nurses, physiotherapists, occupational therapists, speech therapists, medical social workers, pharmacists, care coordinators, case managers and stroke nurse educators.
The stroke team has at its core neurologists dedicated to stroke care. It manages just under a thousand ischemic stroke patients annually. Working seamlessly with interventional neuroradiologists, emergency physicians, neurosurgeons and radiologists, they introduced the Thrombolytic Therapy Programme and Endovascular treatment for acute ischemic stroke. There are ongoing stroke clinical trials currently and they have also participated in various stroke clinical trials. The team leader pioneered Early Supported Discharge (ESD) in 2007 which extends care and rehabilitation into the community.
The Stroke Clinical Pathway ensures the application of best evidence medicine which reduces length of stay, complications and mortality, ensuring optimum outcomes. Figure 1 below shows the improvement in stroke outcome over the past 19 years in NUH. The patient's average length of stay (ALOS) has been decreasing. Mortality rate has also decreased. Unscheduled re-admission rate was maintained at very low rates.
Figure 1: Stroke Pathway Clinical Outcomes ( ALOS, Readmission Rates, Mortality Rates)