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Kamal N, Jeerakathil T, Stang J, Liu M, Rogers E, Smith EE, Demchuk AM, Siddiqui M, Mann B, Bestard J, Lang E, Shand E, Benard M, Collins L, Martin K, Hartley C, Reiber M, Valaire S, Mrklas KJ, Hill MD, Allen D, Anderson B, Angelstand J, Anokye E, Antymniuk C, Arsenault N, Ashman B, Baker K, Bakker J, Balenga D, Berg M, Berry LA, Betzner M, Black L, Blain D, Boutilier T, Brady J, Lynn Brewster S, Brown P, Buchynski K, Bugbee E, Bullard M, Burke D, Burnett C, Butcher K, Cackett P, Canham H, Chiovetti A, Chivers L, Cobb C, Cote M, Coutts S, Currie D, Eric Daniels J, Desouza N, Diebert M, Dixon T, Dotchin J, Duckett S, Dustow V, Dwyer R, Dymond M, Edmond C, Eesa M, Elias N, Elliott T, Empson S, Falls L, Forder M, Foreman R, Forsythe D, Fortier T, Fowler L, Franklin S, Garland J, Garon C, Gerl D, Ghauri I, Gough S, Mark KG, Mary-Lou Halabi G, Halldorson S, Harsch J, Hatcher C, Hebner K, Hemsley R, Holloway D, Holman D, Holsworth S, Holton S, Hull G, Hyciek B, Ibach R, Imoukhuede O, Jeal B, Jill D, Johnson M, Jones O, Kabaroff A, Kalashyan H, Kay F, Kaytor P, Keppy T, King P, Kiszszak S, Klick R, Koshurba E, Kruhlak R, Lacasse J, Lane M, Laughs T, Laut-Barss L, Lavalee P, Leclair T, Linden P, Linderman T, Livingstone J, Lodder M, Lundgard K, Lyle E, Mackenzie K, Malarczuk A, Malfair D, Malone J, Manosalva Alzate H, McCann K, McCarthy S, McKenzie M, McRobert L, Meroniuk D, Millar R, Miller R, Mir B, Montpetit J, Morissette J, Morrison L, Murray-Galbraith F, Mydeen F, Namagiri L, Neidig N, Neil G, Newcommon N, Newell C, Nichol C, Norris C, Norton D, Noseworthy S, O’Hara L, O’Neail S, Orr W, Panes E, Panes T, Paradis J, Parry T, Peacock D, Peebles T, Petersen S, Phelps I, Pooley R, Potvin N, Pryor R, Ramsahoye M, Rashead M, Reedyk K, Reynolds D, Rideout S, Rimmer K, Salih E, San Agustin P, Sandbeck D, Sattar S, Sauter N, Schmidt K, Seib E, Selzler J, Sevcik B, Sharman D, Shuaib A, Smith D, Snider B, Snider J, Stander J, Stephenson C, Stewart C, Stoyberg C, Suranyi Y, Tablin M, Taralson C, Throndson J, Traverse K, van der Nest D, Van Mulligan T, Van Vuuren C, Vanderlinde E, Vilneff R, Volk G, Wall K, Wang DJ(T, Warharft D, Watson J, Weir L, Weiss D, Welch D, Winder T, Winsor W, Woudstra D, Youn D, Young L, Zerna C. Provincial Door-to-Needle Improvement Initiative Results in Improved Patient Outcomes Across an Entire Population. Stroke 2020; 51:2339-2346. [DOI: 10.1161/strokeaha.120.029734] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
Improving door-to-needle times (DNTs) for thrombolysis of acute ischemic stroke patients improves outcomes, but participation in DNT improvement initiatives has been mostly limited to larger, academic medical centers with an existing interest in stroke quality improvement. It is not known whether quality improvement initiatives can improve DNT at a population level, including smaller community hospitals. This study aims to determine the effect of a provincial improvement collaborative intervention on improvement of DNT and patient outcomes.
Methods:
A pre post cohort study was conducted over 10 years in the Canadian province of Alberta with 17 designated stroke centers. All ischemic stroke patients who received thrombolysis in the Canadian province of Alberta were included in the study. The quality improvement intervention was an improvement collaborative that involved creation of interdisciplinary teams from each stroke center, participation in 3 workshops and closing celebration, site visits, webinars, and data audit and feedback.
Results:
Two thousand four hundred eighty-eight ischemic stroke patients received thrombolysis in the pre- and postintervention periods (630 in the post period). The mean age was 71 years (SD, 14.6 years), and 46% were women. DNTs were reduced from a median of 70.0 minutes (interquartile range, 51–93) to 39.0 minutes (interquartile range, 27–58) for patients treated per guideline (
P
<0.0001). The percentage of patients discharged home from acute care increased from 45.6% to 59.5% (
P
<0.0001); the median 90-day home time increased from 43.3 days (interquartile range, 27.3–55.8) to 53.6 days (interquartile range, 36.8–64.6) (
P
=0.0015); and the in-hospital mortality decreased from 14.5% to 10.5% (
P
=0.0990).
Conclusions:
The improvement collaborative was likely the key contributing factor in reducing DNTs and improving outcomes for ischemic stroke patients across Alberta.
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Affiliation(s)
- Noreen Kamal
- Department of Industrial Engineering, Dalhousie University, Halifax, Nova Scotia, Canada (N.K.)
- Department of Clinical Neurosciences (N.K., E.E.S., A.M.D., M.D.H.), University of Calgary, Alberta, Canada
| | - Thomas Jeerakathil
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (T.J., M.S.)
| | - Jillian Stang
- Data Analytics, Alberta Health Services, Canada (J.S., M.L.)
| | - Mingfu Liu
- Data Analytics, Alberta Health Services, Canada (J.S., M.L.)
| | - Edwin Rogers
- Strategic Management Branch, Government of Saskatchewan, Regina, Canada (E.R.)
| | - Eric E. Smith
- Department of Clinical Neurosciences (N.K., E.E.S., A.M.D., M.D.H.), University of Calgary, Alberta, Canada
- Department of Community Health Sciences (E.E.S., K.J.M., M.D.H.), University of Calgary, Alberta, Canada
| | - Andrew M. Demchuk
- Department of Clinical Neurosciences (N.K., E.E.S., A.M.D., M.D.H.), University of Calgary, Alberta, Canada
- Department of Radiology (A.M.D., M.D.H.), University of Calgary, Alberta, Canada
| | - Muzaffar Siddiqui
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (T.J., M.S.)
- Grey Nuns Community Hospital, Edmonton, Alberta, Canada (M.S.)
| | - Balraj Mann
- Cardiovascular Health and Stroke, Strategic Clinical Network, Alberta Health Services, Edmonton, Canada (B.M., S.V.)
| | | | - Eddy Lang
- Department of Emergency Medicine (E.L.), University of Calgary, Alberta, Canada
| | - Elaine Shand
- Red Deer Regional Hospital Centre, Alberta, Canada (J.B., E.S.)
| | | | - Lisa Collins
- North Zone, Alberta Health Services, Cold Lake, Canada (L.C.)
| | - Kevin Martin
- Chinook Regional Hospital, Lethbridge, Alberta, Canada (K.M., C.H.)
| | - Corinna Hartley
- Chinook Regional Hospital, Lethbridge, Alberta, Canada (K.M., C.H.)
| | - Marnie Reiber
- Lloydminster Hospital, Lloydminster, Alberta/Saskatchewan, Canada (M.R.)
| | - Shelley Valaire
- Cardiovascular Health and Stroke, Strategic Clinical Network, Alberta Health Services, Edmonton, Canada (B.M., S.V.)
| | - Kelly J. Mrklas
- Department of Community Health Sciences (E.E.S., K.J.M., M.D.H.), University of Calgary, Alberta, Canada
- System Innovation and Programs, Strategic Clinical Networks, Alberta Health Services, Calgary, Canada (K.J.M.)
| | - Michael D. Hill
- Department of Clinical Neurosciences (N.K., E.E.S., A.M.D., M.D.H.), University of Calgary, Alberta, Canada
- Department of Community Health Sciences (E.E.S., K.J.M., M.D.H.), University of Calgary, Alberta, Canada
- Department of Radiology (A.M.D., M.D.H.), University of Calgary, Alberta, Canada
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