City-Wide Initiatives

Countdown Lights to Optimize Quality in acute Stroke (CLOQS) Trial

We propose a simple, low-cost intervention, applicable to every code stroke patient, to reduce door-to-needle times. We will attach a large, “in-your-face” red LED stopwatch-clock to the patient’s stretcher at the moment of ED arrival to act as a constant visual reminder to all team members (physicians, RN’s, CT technologists) of the urgency of the situation. We hypothesize that this simple visual cue will improve door-to-CT scan times and door-to-needle treatment times, and thus improve response to treatment and reduce adverse events. To our knowledge, this type of intervention has never been published, either in the acute stroke or myocardial infarction literature. This quality improvement intervention is particularly attractive because of its widespread generalizability. Our experience may stimulate the design of similar studies for code STEMI and other time-sensitive treatments. Future studies could also extend into the pre-hospital phase, whereby paramedics could attach a stopwatch onto patients in the field aiming to reduce arrival times.

The CLOQS trial to a city wide initiative encompassing Sunnybrook Health Sciences Centre, St. Michaels Hospital and Toronto Western Hospital (UHN). The study is funded by Sunnybrook Health Sciences Centre’s Academic AFP Innovation Fund.

Source: CLOQs Project Proposal

The ‘Weight Times’ Strategy: A simple, low cost intervention to improve safety in patients receiving thrombolysis for acute stroke

The purpose of this study is to determine the feasibility and utility of introducing a stretcher scale into the work flow of the acute stroke setting. The primary objective is to show that making a simple change to hospital equipment and work flow will enable routine, accurate weighing of all patients in acute stroke situations. Secondary objectives will examine: 1) whether accurate weights effects door-to-CT and door-to-needle times, 2) the incidence of symptomatic and asymptomatic intracranial hemorrhage with accurate-weight dosing of tPA, 3) whether the rates of hemorrhagic complications from accurate-weight tPA dosing are lower than historical controls, 4) how treating physicians initial visual estimate of weights compare to actual measured weights, and 5) the incidence of good response to tPA with accurate-weight dosing.

This strategy will be implemented in four Regional Stroke Centres including the three members of the University of Toronto Stroke Program (UTSP: Sunnybrook Health Sciences Centre, St. Michael’s Hospital and the University Health Network), as well as the Hamilton General Hospital.

Source: Weight-Times Strategy Protocol