Implementation of a provincial acute stroke pathway and its impact on access to advanced stroke care in Saskatchewan
Background For ischaemic stroke, outcome severity is heavily time dependent. Systems of care need to be in place to ensure that patients with stroke are treated quickly and appropriately across entire health regions. Prior to this study, the province of Saskatchewan, Canada did not have a provincial...
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| Language: | English |
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BMJ Publishing Group
2021-07-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/10/3/e001214.full |
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| author | Michael E Kelly Lissa Peeling Jessica Hamilton Laura Schwartz Jessalyn K Holodinsky Vivian N Onaemo Ruth Whelan Gary Hunter Brett R Graham Lori Latta |
| author_facet | Michael E Kelly Lissa Peeling Jessica Hamilton Laura Schwartz Jessalyn K Holodinsky Vivian N Onaemo Ruth Whelan Gary Hunter Brett R Graham Lori Latta |
| author_sort | Michael E Kelly |
| collection | DOAJ |
| description | Background For ischaemic stroke, outcome severity is heavily time dependent. Systems of care need to be in place to ensure that patients with stroke are treated quickly and appropriately across entire health regions. Prior to this study, the province of Saskatchewan, Canada did not have a provincial stroke strategy in place.Methods A quality improvement project was undertaken to create and evaluate a provincial stroke strategy. The Saskatchewan Acute Stroke Pathway was created using a multidisciplinary team of experts, piloted at five stroke centres and then implemented provincially. The number of stroke alerts, door-to-imaging, door-to-needle, door-to-groin puncture times and treatment rates were collected at all centres. Improvements over time were analysed using run charts and individuals control charts.Results The number of stroke alerts province-wide trended upwards in the last 6 months of the study. There were no clear trends or shifts in the proportion of stroke alerts treated with alteplase or endovascular therapy. Across the province, the weighted mean door-to-imaging time decreased from 21 to 15 min, the weighted mean door-to-needle time decreased from 62 to 47 min and the mean door-to-groin puncture time decreased from 83 to 70 min. There was high variability in the degree of improvement from centre to centre.Conclusions The implementation of a province wide acute stroke pathway has led to improvement in stroke care on a provincial basis. Further work addressing intercentre variability is ongoing. |
| format | Article |
| id | doaj-art-04695d2ae78b4083aac2bb4262c9c19d |
| institution | Kabale University |
| issn | 2399-6641 |
| language | English |
| publishDate | 2021-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj-art-04695d2ae78b4083aac2bb4262c9c19d2024-11-25T01:20:08ZengBMJ Publishing GroupBMJ Open Quality2399-66412021-07-0110310.1136/bmjoq-2020-001214Implementation of a provincial acute stroke pathway and its impact on access to advanced stroke care in SaskatchewanMichael E Kelly0Lissa Peeling1Jessica Hamilton2Laura Schwartz3Jessalyn K Holodinsky4Vivian N Onaemo5Ruth Whelan6Gary Hunter7Brett R Graham8Lori Latta9Department of Neurosurgery, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, CanadaDivision of Neurosurgery, Department of Surgery, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, CanadaSaskatchewan Health Quality Council, Saskatoon, Saskatchewan, CanadaSaskatchewan Health Authority, Saskatoon, Saskatchewan, Canada6 Department of Clinical Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, Alberta, CanadaMinistry of Health, Government of Saskatchewan, Regina, Saskatchewan, CanadaDivision of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, CanadaUniversity of Saskatchewan, Saskatoon, Saskatchewan, CanadaDivision of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, CanadaMinistry of Health, Government of Saskatchewan, Regina, Saskatchewan, CanadaBackground For ischaemic stroke, outcome severity is heavily time dependent. Systems of care need to be in place to ensure that patients with stroke are treated quickly and appropriately across entire health regions. Prior to this study, the province of Saskatchewan, Canada did not have a provincial stroke strategy in place.Methods A quality improvement project was undertaken to create and evaluate a provincial stroke strategy. The Saskatchewan Acute Stroke Pathway was created using a multidisciplinary team of experts, piloted at five stroke centres and then implemented provincially. The number of stroke alerts, door-to-imaging, door-to-needle, door-to-groin puncture times and treatment rates were collected at all centres. Improvements over time were analysed using run charts and individuals control charts.Results The number of stroke alerts province-wide trended upwards in the last 6 months of the study. There were no clear trends or shifts in the proportion of stroke alerts treated with alteplase or endovascular therapy. Across the province, the weighted mean door-to-imaging time decreased from 21 to 15 min, the weighted mean door-to-needle time decreased from 62 to 47 min and the mean door-to-groin puncture time decreased from 83 to 70 min. There was high variability in the degree of improvement from centre to centre.Conclusions The implementation of a province wide acute stroke pathway has led to improvement in stroke care on a provincial basis. Further work addressing intercentre variability is ongoing.https://bmjopenquality.bmj.com/content/10/3/e001214.full |
| spellingShingle | Michael E Kelly Lissa Peeling Jessica Hamilton Laura Schwartz Jessalyn K Holodinsky Vivian N Onaemo Ruth Whelan Gary Hunter Brett R Graham Lori Latta Implementation of a provincial acute stroke pathway and its impact on access to advanced stroke care in Saskatchewan BMJ Open Quality |
| title | Implementation of a provincial acute stroke pathway and its impact on access to advanced stroke care in Saskatchewan |
| title_full | Implementation of a provincial acute stroke pathway and its impact on access to advanced stroke care in Saskatchewan |
| title_fullStr | Implementation of a provincial acute stroke pathway and its impact on access to advanced stroke care in Saskatchewan |
| title_full_unstemmed | Implementation of a provincial acute stroke pathway and its impact on access to advanced stroke care in Saskatchewan |
| title_short | Implementation of a provincial acute stroke pathway and its impact on access to advanced stroke care in Saskatchewan |
| title_sort | implementation of a provincial acute stroke pathway and its impact on access to advanced stroke care in saskatchewan |
| url | https://bmjopenquality.bmj.com/content/10/3/e001214.full |
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