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Through hard work, QHC’s door-to-needle time for Code Strokes crashes downward

We absolutely LOVE to improve at Quinte Health Care. In fact, ‘Always Strive to Improve’ is one of our organization’s values. So the incredible results stemming from a Code Stroke improvement (Kaizen) event from July 2019 has us shouting from the rooftops!

The two-day improvement event, attended by a large group of highly engaged QHC staff, physicians and community partners including Hastings Quinte Paramedic Services, focused on speeding up our Code Stroke process because, with strokes, time is brain. The speed in which a stroke patient receives clot-busting tPA (aka the door-to-needle time) undoubtedly impacts their future quality of life. Upon ambulance arrival to hospital, the goal is to get the patient assessed by the physician and down for a CT scan as quickly as possible to determine whether they are a candidate for tPA (only 1 in 5 patients qualify, as it depends on the type of stroke).

In 2018, QHC’s median door to needle time was 61 minutes. At the time of the improvement event in July 2019, QHC’s median door-to-needle time was 45 minutes.  Today, QHC’s median door to needle time is 37 minutes!

“It’s exciting when you see what we’ve done,” said James Russell, QHC’s Director of Process Improvement. “We’ve knocked almost half the time off over a span of two years, which is incredible.”

During the improvement event, QHC’s Process Improvement team looked for efficiency opportunities, but allowed the nurses, doctors, technicians etc. doing the Code Stroke duties to design the new plan. They role played to test out different processes and kept tweaking in the following months.

“We pulled the process apart minute-by-minute, and that was huge,” said Melissa Roblin, Stroke Resources Nurse. “We also focused on role clarity and provided education to the teams involved.”

“Role clarity has helped create a coordinated symphony between the emergency department, intensive care unit and diagnostic imaging,” said James. “Everyone is just there and knows what to do.”

“I’ve noticed a huge difference in the collaboration between ER and ICU nursing since the Kaizen event,” said Emma Holmes, an RN in the ICU. “I went to a Code Stroke the other day and the other nurse and I were discussing how much better the whole process is. We all know our roles and work together to ensure timely care for the patient.”

Derk Damron, District Stroke Coordinator, gives kudos to the Diagnostic Imaging team, which was already performing very well, but managed to tweak their processes even more to shave time. “It’s been a big team effort over many departments and I want to acknowledge the nursing managers and all the physicians, nurses, and technicians for making this a priority.

Dr. Andrew Samis, physician lead for stroke care at QHC, summed up the success by saying, “The improvement in door-to-needle time is so much more than I ever imagined, and the best part is that the real winners in this are the patients and their families in the Quinte, Hastings and Prince Edward region where these improvements represent less disability and longer lives after a stroke.”

A big thank you to everyone who attended the event and put in many hours of hard work to help achieve better outcomes!

QHC's median door-to-needle time has improved dramatically from 2018 to 2020!