Striving for Success: An In-hospital & Pre-hospital Approach

Country: 
Vietnam

By Hai Le, Stroke Care Program Specialist and Cam-Tu Vo, Stroke Care Program Manager

Stroke is the number one cause of mortality in Vietnam1.

An estimated 200,000 new stroke cases are reported each year, 50% of which are fatal. Furthermore, the mortality rate of this disease surpasses those of other serious illnesses such as cardiovascular diseases and cancer.

Da Nang Hospital, one of the major hospitals in Central Vietnam, provides medical care for a population of about 1.1 million people in Da Nang city, as well as people in the surrounding provinces. With the high mortality rate of stroke in the country, the hospital began treating stroke patients in 2015, with 48 tPA cases per year out of 2,000 admissions. The average door-to-needle (DTN) time was 72 minutes, with only one stroke physician in charge of the Stroke Unit in the Intensive Care Unit (ICU) department.

As part of efforts to tackle stroke in the country, Da Nang Hospital joined the Angels Initiative in 2018. With strong support from the hospital’s Board of Directors and the unyielding efforts of the stroke team, several measures have been implemented:

  • Stroke bags are now utilized at the CT scan stage, which saves 4-5 precious minutes
     
  • Weekly internal meetings for the stroke care team to share updates, exchange knowledge, as well as pinpoint gaps in processes to highlight areas for continuous improvement
     
  • Active participation in the Angels webinars, Body Interact training, WOW CT training, and nurses training, with the goal of improving treatment decision-making
     
  • Quality monitoring via the Helsinki poster to ensure quality of care
     
  • Enhancements to the pre-hospital phase through the creation of a hotline for stroke incidents, as well as implementation of “FAST” training for Emergency Medical Services (EMS) staff and emergency physicians of referral hospitals to pre-notify stroke units while transferring patients
     
  • Support for satellite hospitals through telemedicine (Zalo group) to offer treatment for stroke patients

Since these initiatives have been put in place, the number of treated cases have significantly increased from 118 cases with a 5% thrombolysis rate in 2018, to 200 cases with an 8% thrombolysis rate in 2019. Additionally, DTN time has been reduced considerably from 55 minutes to 33 minutes in the same period.

With the joint goal to “give life a chance”, the Da Nang stroke team and the Angels team are enthusiastic and dedicated to enhancing treatment quality for stroke patients, to reduce DTN time, and consequently, to increase survival rates. In addition to saving more lives, the hospital joined the Quality Registry RES-Q and now the team also hopes to qualify for the 'Platinum' award by the World Stroke Organization (WSO) Angels Awards which recognizes hospitals that demonstrate a clear commitment to quality stroke care.

“We should not be complacent with the current results. Instead, we will strive to do even better, as our goal is to increase the number of patients treated in stroke-ready hospitals nationwide,” said Dr Nguyen Thanh Trung, Vice Director of Da Nang Hospital & Dr Duong Quang.

1Vietnam. (2020). Retrieved 25 February 2020, from http://www.healthdata.org/vietnam