PEMBROKE – When it comes to optimal stroke care, every minute counts which is why the Pembroke Regional Hospital’s District Stroke Centre has teamed up with the County of Renfrew Paramedic Service to roll out a new best practice model of care which will help decrease what’s known as “door to needle time”.
Vascular Health Coordinator Karen Roosen explains that “door to needle time” refers to a specific time frame within which tPA (Tissue Plasminogen Activator), a clot-busting drug used to treat certain types of strokes, can be administered to a stroke patient who has arrived at the Emergency Department.
Although the current door to needle time at PRH has improved significantly by dropping to 46 minutes from 63 over the past 2 years, the provincial benchmark also continues to drop as new procedures are developed.
“By implementing the new procedures, we are striving to reduce our ‘door to needle time’ to 30 minutes,” Mrs. Roosen said. She noted that one of the key components of this initiative involves the stroke patient remaining on the paramedic’s stretcher from the time they are triaged and assessed in the Emergency Department through to completion of a CT scan.
This initiative is already a best practice in Code Stroke management at Quinte Health Centre in Belleville where local representatives conducted a site visit to learn more about the process and what is required.
“Keeping the patients on the ambulance stretchers rather than transferring them to one of ours saves time and has been proven to significantly reduce door to needle time,” Mrs. Roosen said.
Dave Libby, Acting Chief for the County of Renfrew’s Paramedic Service said they are very excited to be part of this initiative recognizing how much of a positive impact it will have on the patients and the community.
Jim Lumsden, Director of Diagnostic Imaging at PRH said the new Code Stroke protocol will save valuable minutes during a critical time, and allow more people to return home to their family and loved ones. “This is another great example of Renfrew County residents receiving world class stroke care close to home,” Mr. Lumsden said.
As a District Stroke Centre for the region, the Pembroke Regional Hospital is recognized province-wide as being a high performer for the transfer of stroke patients to stroke rehabilitation within five days of admission versus the provincial benchmark of six days.
PRH is also the only site in the Champlain LHIN (Local Health Integration Network) to meet the provincial definition for designation as an integrated stroke unit – which means that all the stroke unit beds for both acute care and rehabilitation are located in the same area of the hospital and a dedicated inter-professional team with stroke expertise (nursing, physiotherapy, occupational therapy and speech-language pathology) is managing the patient’s care. The model, which is designed to meet individual stroke care needs, supports a seamless transition of patient care from acute care to rehabilitation.
Mrs. Roosen said that’s good news for the 160 patients who were admitted to the PRH District Stroke Centre just in the last year. All stroke patients within Renfrew County, regardless of whether or not they are eligible for tPA, benefit from the existence of regional integrated stroke unit as it allows for management of the acute care needs of patients who have had a stroke, and as soon as they are ready and appropriate for rehabilitation, transitions them directly into the intensive rehabilitation program.
Our data also shows that residents across Renfrew County have been calling 911 and are utilizing Paramedic Services appropriately when experiencing possible signs or symptoms of a stroke. It has been shown that in the past year, 88% of the hospital’s stroke patients arrived at the Emergency Department by ambulance, exceeding the provincial benchmark of 65%.
“We can’t stress enough ,the urgency to call 911 if you or a loved one experiences any possible signs of a stroke such as drooping face, an inability to raise both arms, or slurred speech” Mrs. Roosen said.
One of many advantages in calling 911, is that Emergency Medical Services can dispatch ahead to PRH to get the stroke care team mobilized. The team will be ready to determine the type of stroke when you arrive so that the appropriate treatment can start as soon as possible. Remember “Time is Brain” and can save lives when dealing with a possible stroke!
