Stroke is a common clinical condition and the most common cause of disability in 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, neurosurgeons, emergency physicians, radiologists, rehabilitation physicians, 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 five neurologists dedicated to stroke care and it manages just under a thousand ischaemic stroke patients annually. Working seamlessly with emergency physicians, neurosurgeons and radiologists, they manage the Stroke Pathway and introduced the Thrombolytic Therapy Programme for acute ischaemic stroke in 1998. This is in addition to participating in 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 17 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.
Figure1: Stroke Pathway Clinical Outcomes ( ALOS, Readmission Rates, Mortality Rates)