The journey of improving stroke care in Nova Scotia, Canada, offers a compelling case study for healthcare practitioners aiming to enhance their skills and systems. Over 14 years, a comprehensive project led by Cardiovascular Health Nova Scotia (CVHNS) demonstrated that strategic interventions and collaborative efforts could significantly improve stroke outcomes. This blog explores the key outcomes of this initiative and how practitioners can apply these lessons to their own practices.
The Need for Change
Stroke is a complex disorder that presents significant challenges to healthcare systems worldwide. An audit conducted in Nova Scotia in 2004-2005 revealed that many aspects of stroke care delivery fell short of national best practice recommendations. Recognizing the need for systemic change, the province embarked on a journey to reorganize stroke care through evidence-based interventions.
Key Interventions and Outcomes
- Stroke Unit Care: The proportion of patients receiving multidisciplinary stroke unit care rose from 22.4% in 2005 to 74.0% in 2019. This was achieved by establishing a network of stroke units across the province, facilitating coordinated care by specialized teams.
- Thrombolytic Therapy: The use of alteplase increased from 3.2% to 18.5%, with the median delay between hospital arrival and administration decreasing from 102 minutes to 56 minutes. This was accomplished without an increase in intracranial hemorrhage incidents.
- Dysphagia Assessment: Screening rates increased from 41.4% to 77.4%, highlighting the importance of early assessment in preventing complications.
The success of these interventions was largely attributed to the development of a provincial network that facilitated ongoing collaboration and structured information exchange. The creation of roles such as stroke coordinator and stroke physician champion played a crucial role in driving these changes.
The Role of Collaboration and Continuous Improvement
A critical factor in the success of this initiative was the establishment of a collaborative network that enabled continuous improvement. By fostering communication among stakeholders and providing regular feedback through data collection, the project maintained momentum over its long duration.
The project also faced challenges, such as competing priorities within the healthcare system and resistance to change among staff. However, the commitment to continuous quality improvement ensured that these obstacles were addressed effectively.
Implications for Practitioners
The lessons learned from Nova Scotia's experience offer valuable insights for practitioners seeking to improve stroke care or other complex healthcare systems:
- Cultivate Collaboration: Building networks that facilitate communication and knowledge sharing can drive improvements across multiple sites.
- Pursue Continuous Improvement: Regular data collection and feedback enable practitioners to adapt strategies and sustain progress over time.
- Create Specialized Roles: Designating roles such as coordinators or champions can provide leadership and focus for specific areas of improvement.
The Path Forward
The success story from Nova Scotia underscores the potential for significant improvements through strategic planning and collaboration. Practitioners are encouraged to explore further research opportunities to build upon these findings and apply them within their own contexts.
Improving stroke care in Nova Scotia, Canada: a population-based project spanning 14 years
