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Improving outcomes for patients with speedy and coordinated stroke treatment

3-6-2019

Stroke Treatment

People experiencing a stroke in Windsor/Essex are getting quicker access to potentially life-saving treatment thanks to a coordinated effort led by WRH and Essex-Windsor Emergency Medical Services (EMS).

Door-to-needle time measures the time it takes patients arriving in the emergency department after having a stroke to receive a clot-busting drug known as tPA. The drug can prevent brain damage and significantly increase a patient’s chance of a full recovery, but only if given within a narrow window of 4.5 hours after symptoms begin.

Dr. Michael Winger, Medical Director of the Enhanced District Stroke Centre for Windsor-Essex says when treating stroke patients, every second counts. “We say, ‘time is brain,’ because every minute it takes to get the blood circulating back to a patient’s brain, 2 million brain cells die.”

Thanks to recent process improvements, patients arriving at the hospital after a stroke are being diagnosed and receiving the treatment 53% faster than they were just three years ago.

The opportunity to begin improving the stroke treatment process came with the realignment of hospital services in 2013.

“With both acute care campuses under the same leadership, we could standardize stroke care and ensure patients are directed to the right place for quick, specialized services,” says Denise St. Louis, Manager of the District Stroke Centre at WRH.

One of the first changes was to direct all patients experiencing stroke symptoms within the time window for treatment, to the District Stroke Centre, at the Ouellette Campus.

“By creating one Centre of Excellence where all stroke patients are treated, we ensure we have the right team and equipment in place to obtain the best outcomes for our patients,” says St. Louis.

Another change to the process includes a phone call from paramedics in the field to the neurologist on call when a potential stroke patient is identified. This activates the process so the neurologist is notified earlier and can expedite testing so treatment decisions, including the use of tPA, can be made quickly.

Thanks to these changes, the door-to-needle time has dropped from 95 minutes to 49 minutes in two years.

“We now have a system where we can treat stroke patients quickly in order to improve their outcomes, prevent disability and limit and sometimes reverse devastating effects,” says St. Louis.

Because of the quicker response times, more patients are now able to receive the drug within the very short window of time after symptoms begin. The percentage of patients eligible for the treatment has doubled since work on process improvements began and is now above the provincial average.

Dr. Winger says the new process works because it is simple, straight forward and automatic. In addition, he says the door-to-needle time will only improve when the centre moves to a new single-site acute care hospital.

Last year, WRH saw 1435 potential stroke cases. Sixty-four percent of the cases were from within the City of Windsor, while 36% were from locations in Essex County.

“The central location of the new hospital will allow us to get people in from all areas of Essex County quickly and start treatment,” says Dr. Winger.

The central location will also benefit patients who travel from outside the region to receive a surgical treatment called Carotid Endarterectomy. This year, 37% of patients who received this surgical procedure to reduce the risk of a stroke came from Chatham-Kent and Sarnia Lambton.

Dr. Winger says he is also looking forward to the functional planning stage of the new facility, where the process of treating stroke patients can be further enhanced. He says with the right layout, efficiencies can be built into the design to speed up the flow of patients from the emergency department to diagnostic imaging and then to the stroke unit.

The improved process is one piece of the work the District Stroke Centre is doing to improve patient care. They are also working with partners in the community including HDGH and the LHIN to improve the journey after stroke patients are discharged from WRH.

The team is now pursuing Accreditation Canada’s Stroke Distinction for stroke care.

WATCH: When someone is having a stroke, EVERY MINUTE COUNTS! This video highlights a coordinate effort lead by WRH and Essex-Windsor EMS to get stroke patients timely access to treatment.