Abstract
Stroke is a significant cause of admission to Singapore's acute care hospitals. Because of the current COVID-19 pandemic, there have been major changes in the stroke care system. On calling for the public ambulance, those suspected to have COVID-19 infection are taken to the National Center for Infectious Diseases. Otherwise, on arrival at the emergency room, all cases with fever or respiratory symptoms [COVID-19 suspect patients (CSPs)] are evaluated separately by staff wearing full personal protective equipment (PPE). Triage is not delayed. CSPs needing hyperacute therapies are sent to a specially prepared scanner; if not, imaging is deferred to the latter part of the day. CSPs are managed in isolation rooms, and sent to the acute stroke unit (ASU) if two consecutive COVID-19 swabs are negative. Investigation and rehabilitation are done within the room. ASU rounds are attended by essential members, communication by electronic means. Multidisciplinary team rounds have largely ceased, and discussions are via electronic platforms. Patient transfer and staff movement are minimized. All hospital staff wear face-masks, infection control is strictly enforced. Visitors are not allowed; staff make daily calls to update families. Mild stroke patients may be sent home with rehabilitation advice. Out-patient rehabilitation centers are closed. Patients return for out-patient visits only if needed; medications are sent to their home, and nurses make essential home visits. Stroke support and rehabilitation activities have started on-line. Continuing medical education activities are mainly by webinars. Stroke research has been severely hampered. Overall, evidence-based stroke care is delivered in a re-organized manner, with a clear eye on infection control.
Highlights
The current COVID-19 pandemic has had a significant impact on global economic, political, social, emotional, and medical health
Prior to the COVID-19 pandemic, patients calling for the national ambulance service who were assessed as possibly having a stroke were transported directly to one of three thrombolysis/thrombectomy centers if they met the time windows, or, if not, to the nearest of the seven restructured hospitals or a collaborating private hospital scattered throughout the country
There is a pool of interventional radiologists and trained staff, allowing for multiple thrombectomy teams in each of the three dedicated centers, in order to cater for the eventuality that if one EVT team encounters a confirmed COVID-19 case without adequate protection, that whole team may need to be quarantined for many days
Summary
Reviewed by: Po-Yu Lin, National Cheng Kung University Hospital, Taiwan Chih-Hao Chen, National Taiwan University Hospital, Taiwan. Stroke is a significant cause of admission to Singapore’s acute care hospitals. Because of the current COVID-19 pandemic, there have been major changes in the stroke care system. On calling for the public ambulance, those suspected to have COVID-19 infection are taken to the National Center for Infectious Diseases. On arrival at the emergency room, all cases with fever or respiratory symptoms [COVID-19 suspect patients (CSPs)] are evaluated separately by staff wearing full personal protective equipment (PPE). CSPs are managed in isolation rooms, and sent to the acute stroke unit (ASU) if two consecutive COVID-19 swabs are negative. Mild stroke patients may be sent home with rehabilitation advice. Stroke support and rehabilitation activities have started on-line. Evidence-based stroke care is delivered in a re-organized manner, with a clear eye on infection control
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