Door-to-Needle Initiative
QuICR has improved Door-to-Needle (DTN) times across Alberta. We have an aggressive target to reduce the median DTN time to 30 minutes, and to have 80% of all patients treated within 60 minutes.
We used IHI's Improvement Collaborative Methodology. Background on the Improvement Collaborative Methodology can be found on IHI's White Paper on the Breakthrough Series Collaborative.
Access the QuICR DTN Improvement Package
Learning Session 1 (Calgary, Sept. 29, 2015): Agenda
Dr. Michael Hill - The need for speed. Why we need to improve door-to-needle times?
Dr. Tom Jeerakathil - QuICR Door-to-Needle Improvement Collaborative
Dr. Eric Smith - QuICR Door-to-Needle Improvement Collaborative
More Presentations
Presentation Slides: St. Mary's DTN improvements (Presenter: Dana Norton)
Presentation Slides: Red Deer's DTN Improvements (Presenter: Dr. Jennifer Bestard)
Presentation Slides: Lethbridge's DTN Improvements (Presenter: Kevin Reedyk)
Additional Resources
DTN Collaborative Change Package
Link to Paper:
Kamal N, Benavente O, Boyle K, Buck B, Butcher K, Casaubon LK, Côté R, Demchuk AM, Deschaintre Y, Dowlatshahi D, Gubitz GJ, Hunter G, Jeerakathil T, Jin A, Lang E, Lanthier S, Lindsay P, Newcommon N, Mandzia J, Norris CM, Oczkowski W, Odier C, Phillips S, Poppe AY, Saposnik G, Selchen D, Shuaib A, Silver F, Smith EE, Stotts G, Suddes M, Swartz RH, Teal P, Watson T, & Hill, MD. Good is not good enough: the benchmark stroke door-to-needle time should be 30 minutes. Canadian Journal of Neurological Sciences. 2014;41(06):694-696. doi:10.1017/cjn.2014.41
Learning Session 2 (Calgary, Nov. 24, 2015): Agenda
Darla Reynolds - DTN Improvements at Grey Nun's and UA Hospital
John Montpetit - Interfacing with RAAPID
Kara Rimmer - Changes at Westlock
Caroline Stephenson - Creating a Stroke Kit
Dr. Thomas Jeerakathil - Where tPA is Administered
More Presentations
Presentation Slides: Red Deer - Making an impact and seeing the results
Learning Session 3 (Calgary, March 8, 2016): Agenda
Noreen Kamal - Introduction How Far Have We Come? Review of Data
Donna Sharman - Patient Experience
Dr. Eric Smith - Taking a Look Internationally
Noreen Kamal - Update on Terminology
Dr. Andrew Demchuk - The ERA Project Access to Endovascular Treatment in Alberta
Dr. Thomas Jeerakathil & Dr. Michael Hill - Telestroke Process with Consideration of Transport for Endovascular Treatment
Fort McMurray - Achieving Fast DTN times
Dr. Thomas Jeerakathil - Rapid CTA at Primary Stroke Centres
Dr. Thomas Jeerakathil - Fast Thrombolysis and Safety
Closing Celebration (Edmonton, Sept. 23, 2016): Agenda
All Stroke Centres in Alberta (17 Hospitals) have been working hard to reduce door-to-needle times at their centre. There have been tremendous gains made, and Alberta is now one of the top performing Stroke Systems in the World.
On September 23 2016, we held our Closing Celebration in Edmonton, AB. This day will provided a forum that recognized each of you for your extraordinary work, presented what we have achieved, and provided ways to continue to improve and sustain these successes.
Posters:
- Overall QuICR Poster (Alberta)
- Brooks Health Centre
- Chinook Regional Hospital (Lethbridge)
- Cold Lake Healthcare Centre
- Foothills Medical Centre (Calgary)
- Grey Nuns Community Hospital
- Hinton Healthcare Centre
- Lloydminster Hospital
- Medicine Hat Regional Hospital
- Northern Lights Regional Health Centre (Fort McMurray)
- Northwest Health Centre (High Level)
- Peace River Community Health Centre
- Queen Elizabeth II Hospital (Grand Prairie)
- Red Deer Regional Hospital Centre
- St. Mary's Hospital (Camrose)
- University of Alberta Hospital (Edmonton)
- Wainwright Health Centre
- Westlock Healthcare Centre
Additional Presentation Slides
Dr. Michael Hill - Introductions
Shelley Castor - Patient Story: the story of fast DTN time
Dr. Blair O'Neil - The Importance of This Work? AHS Perspective
Noreen Kamal - A year in review: the changes and the data
Dr. Eric Smith - Putting Alberta on the World Stage
Dr. Michael Hill - Impacting system wide change for acute stroke care
Dr. Thomas Jeerakathil - DTN Inititiative and it's Implication on EVT
Dr. Jennifer Bestard - Red Deer Regional Hospital: How a community hospital showed the tertiary hospitals
Kara Rimmer - Nurse at Westlock Healthcare Centre
Ron Smith - 2012 Stroke Patient
Noreen Kamal - Continuing, Sustaining and Spreading your improvements
Additional Presentation Slides
Action Period - Webinars
EMS Pre-notification:
St. Mary's Direct-to-CT Process:
Rapid Imaging at Primary Stroke Centres:
DTN Successes at Fort McMurray:
Nephrotoxicity of Contrast Imaging: Understanding the Actual Risk
Warfarin and Thrombolysis: What are the Risks?
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Presentation Slides: Warfarin and Thrombolysis: What are the Risks? (Presenter: Jessalyn Holodinsky)
Implementing Changes at Your Site to Reduce DTN Time
Case Reviews: QEII and Grey Nun's
Case Reviews: Chinook Regional Hospital
Case Reviews: Westlock Regional Hospital
Interviews
Interviews recorded at Learning Session 1 (Sept 29 2015)
QuICR and DTN Initiative Overview - Dr. Michael Hill
Dr. Jennifer Bestard - Neurologist, Red Deer Regional Health Centre
Endovascular Therapy: Dr. Andrew Demchuk - Stroke Neurologist, Foothills Medical Centre
Improvements at FMC: Dr. Eric Smith - Stroke Neurologist, Foothills Medical Centre
Dr. Thomas Jeerakathil - Stroke Neurologist, University of Alberta Hospital
St. Mary's Hospital - Janice Throndson and Kim Roberts, Camrose, AB
EMS - Renee Vilneff
Interviews recorded at Learning Session 2 (Nov 24 2015)
RAAPID - Keith Carlson, John Montpetit, Doug Burke
Emergency Nurse - Richard Hemsley, Grey Nun's Hospital
Westlock Hospital - Kara Rimmer, Manager
Imaging: CT and CTA - Dr. Michael Hill and Dr. Thomas Jeerakathil
Interviews recorded at Learning Session 3 (Mar 8 2016)
Stroke Survivor - Andy and Donna Sharman
Preparing tPA - Elaine Shand, RN
Preparing CT and CTA - Mona Diebert, DI
Tele-Stroke - Dr. Thomas Jeerakathil