Facility Engagement is a provincial initiative that aims to strengthen relationships, engagement and communication between health authorities and facility-based physicians, dentists and midwives, to improve their work environment and the delivery of patient care.
In the fall of 2018, Dr. Erica Casey gathered staff from VJH’s Radiology, Emergency Medicine, Neurology, and Emergency Medical Services Departments with the objective of holding interdisciplinary rounds. The goal was to educate health care providers involved with hyperacute CVA (Cerebrovascular accident, or stroke) management on the recent changes in the 2018 Canadian Best Practice guidelines.
Dr. Aleksander Tkach (a visiting Kelowna General Hospital neurologist) provided extensive information and expertise on pre-hospital management and screening of patients with signs and symptoms of CVA, emphasizing the importance of pre-hospital notification in hyper-acute CVA management.
Evidence was presented on the value of general population education on stroke signs and symptoms, efficient and timely emergency medical services (EMS) activation and screening, pre-hospital notification and efficient emergency room physician (ERP) assessment upon arrival to the Emergency Department (ED). The objective of each of these was to have quicker door-to-door needle times for tissue plasminogen activator (tPA) administration.
A tour of the radiology unit was conducted to view where the CT scanner was located in relation to the VJH emergency department. This was followed by a tour of the ED, review of its configuration, and discussion around ways to expedite patient arrival to the ED, and transport to the CT scanning suite.
Action and Outcomes
A VJH CVA Stroke Team Activation Code has been instituted into real time in our ED since this fall meeting, and the Vernon working group has received provincial recognition for its timely action and leadership in management processes.
“Education on this topic has updated our staff collectively and changed our practice as a group”, states Dr. Casey. ERP’s are now working on quicker door-to-needle times for (tPA), radiology is in agreement with CT + CT-A on all cases, which are quickly assessed by ERP’s, and deemed appropriate Stroke Code activations, and patients are being transferred to Vancouver General Hospital for endovascular therapy (EVT).
Overall, the objectives of the meeting were exceeded and we already see practice changes in our Emergency Department. Healthcare providers involved in the management of CVA are up to date on guideline changes which have rolled out and have been put into practice. In turn, this is optimizing patient care in keeping with the latest best practices in Canada.