"Millions and millions of brain cells die every minute when someone suffers a stroke," said Emergency Nurse Educator Jennifer Payne.
Considering how much brain damage a stroke causes every minute, it's critical for patients to receive the drug tPA as soon as possible. Tissue plasminogen activator, known as tPA, can dissolve blood clots that are blocking an artery to the brain. This restores the blood flow and prevents more brain cells from dying. The sooner tPA is given to patients after they suffer a stroke, the more effective it is.
That's why The Ottawa Hospital's Door-to-Needle program aims to shorten the time between when stroke patients come through the Emergency Department doors and when they are injected with tPA.
"The faster you give it, the better the chance someone has of recovering from their stroke," said Dr. Grant Stotts, Director of The Ottawa Hospital Stroke Program.
In June, the stroke team, made up of doctors and nurses from the Emergency and Neurology departments, set a Canadian door-to-needle record of eight minutes.
This is an incredible achievement considering it took an hour when the program started 10 years ago. In 2012, the time was reduced to 45 minutes and in 2013, the team set a Canadian record of 12 minutes.
"We strive for under 30 minutes now: arrival time to needle," said Payne. "About 25 minutes is the time it takes to make the decision to give the tPA drug." However, she added, the team often succeeds in doing it under 20 minutes.
Every patient must be accurately assessed before the drug is administered, including a CT brain scan. After examining the scan, the neurology team decides whether the patient should get tPA. So, how do you go faster? Dr. Stotts said the team works to improve the system – figuring out how to do each step to make it safer and faster.
"There has been analysis at every step of the process to see where those time improvements can be made," said Cari Poulin, Emergency Department Nurse Educator at the Civic Campus of The Ottawa Hospital. One of those improvements includes bringing a toolbox with tPA and necessary stroke treatments to the scanner with the patient.
In June, the Emergency Department was alerted by the Queensway Carleton Hospital that a stroke patient had been assessed and was on the way to the Civic Campus. When the ambulance arrived, the team was ready. It put its system into action and administered the tPA within minutes of arrival.
"We had the fastest time in Canada at eight minutes," said Dr. Stotts.
He said the best practices to speed up door-to-needle times are shared with other stroke teams in hospitals across Canada. "We are one of the leaders, and so what we do influences everybody around us."
The stroke team's ability to improve the drug delivery time is testament to its commitment to world-class care.
Pictured above: When someone suffers a stroke, speed is essential in identifying whether they need to receive the clot-busting drug tPA. One way to speed up the process is to bring a toolbox with tPA and necessary stroke treatments to the CT scanner with the patient, so the drug can be given sooner.