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

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:

 

​​​Additional Presentation Slides

Awards Ceremony

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

Awards Ceremony

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?

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