When every second counts
MUHC patients with acute strokes will be assessed and treated at the right place, at the right time and by the right professionals thanks to ultra-specialized stroke centres at the MGH and MNH. From left to right, Rosa Sourial, clinical nurse specialist in the MUHC Stroke Program; Heather Perkins, nurse clinician in the Stroke Prevention Clinic; Dr. Robert Côté, neurologist and medical director of the MUHC Stroke Program.
Two McGill University Health Centre (MUHC) hospitals have recently received new accreditations: the Montreal General Hospital (MGH) was designated a secondary stroke centre and the Montreal Neurological Hospital (MNH), a tertiary stroke centre. The accreditations were granted after a successful reorganization of services that has optimized speed and quality of care for stroke patients. So, it was with great pride that around 40 members of the MUHC Stroke Program and MUHC administrators celebrated the news.
“The MUHC is the only medical institution in Quebec to have a tertiary and a secondary stroke centre,” says Neurologist Dr. Robert Côté, medical director of the MUHC Stroke Program. “Both units are ultra-specialized and provide rapid assessment, diagnostics and treatment for any type of stroke intervention. The only difference between them is that the MNH has interventional neuroradiology (INR), a procedure used to retrieve clots inside the arteries.”
The transformation of services is part of a stroke strategy put in place by the Ministry of Health in 2013 to improve stroke prevention and healthcare services offered to the more than 12,000 Quebeckers who experience a stroke every year. For every one of them, time is of essence.
“Time is brain,” says Dr. Côté. “For every minute a stroke is left untreated, 2 million brain cells are destroyed. So, the sooner we treat patients the higher the chances of survival with fewer disabilities. That’s better for patients and their families, of course, but it’s also cost effective.”
In the last two years, a Stroke Coordinating Committee, with representatives from the MGH and MNH, worked diligently to fulfill the ministry’s long list of criteria and receive the accreditation. One important requirement was that each unit have a dedicated stroke team.
“That means that the same professionals will follow a patient from admission until discharge,” explains Rosa Sourial, clinical nurse specialist in the MUHC Stroke Program. “Furthermore, a nurse clinician facilitates continuity of care throughout the hospitalization and collaborates with patients, families and the stroke team in planning the next phase of recovery which involves rehabilitation and follow up in the MUHC Stroke Prevention Clinic.” (Please see : Upgraded Stroke Prevention Clinic improves health services offered by the MUHC)
The two centres also reviewed and improved their procedures to fulfil three other requirements: improve access to diagnostic testing, decrease the length of stay of patients and engage patients and families in the plan of care.
“Although patient experience hasn’t been formally tested, a survey carried out by nurse managers in both units indicated that patients and families feel they are better informed about stroke care,” says Sourial.
The improvements in access, continuity and quality of care in both units also benefit patients who were not initially targeted by the stroke program, such as those with transient ischemic attacks (TIA). The success in the transformation is even more meaningful because it was achieved during a challenging time.
“We underwent the rigorous process of accreditation in a context of budget constraints and in the middle of the transition of the Royal Victoria Hospital, which was the entry point for our stroke patients, to the Glen,” says Dr. Côté.
As Rosa Sourial puts it, the whole process has been “a lot of work, but a fun ride”.
“Our teams joined forces to improve the health of the population and we can see the results,” she says. “This is not about us, but about our patients. I hope the two stroke centres will get even better in the future.”
New Receiving Area at the Montreal Neurological Hospital
With the move of the Royal Victoria Hospital activities to the new Glen site, Urgences-Santé now brings Cincinnati positive score acute stroke patients to the new Receiving Area of the MNH. The RA is located within and managed as part of the MNH Intensive Care Unit and is supported by two stretchers, with dedicated ICU equipment; an in-house Neuro intensivist physician and an Assistant Nurse Manager covering the unit 24 hours 7 days per week; as well as additional clinical and administrative staff.
Upgraded Stroke Prevention Clinic improves health services offered by the MUHC
The accreditation work at the two stroke centres had another major positive result. For the past year, the MUHC Stroke Prevention Clinic (SPC) located at the Montreal General Hospital (MGH) has been offering enhanced acute evaluation services to patients with a transient ischemic attack (TIA).
“A TIA produces similar symptoms to those of a stroke such as sudden weakness on one side of the body, face droopiness or difficulties finding words, says Heather Perkins, nurse clinician in the Stroke Prevention Clinic. “It usually lasts only a few minutes and often causes no permanent damage, but should be taken seriously, because these patients are at higher risk of having a stroke.”
The clinic accepts referrals from emergency departments and general practitioners in the community. It has the same access to radiology and ultrasound equipment as the Emergency Department so that all exams can be done as soon as is needed. It also follows up on patients recovering from a stroke and quickly refers them to rehab specialists.
Along with the new services, the clinic pursues its main vocation: to educate healthcare workers and patients about TIAs and strokes. As Neurologist and Medical Director of the MUHC Stroke Program Dr. Robert Côté explains, “The Stroke Prevention Clinic is extremely important. We can treat patients for acute stroke and send them to rehabilitation, but we don’t want them to come back with another stroke.”