Retooling stroke care for the pandemic

COVID-19 changed health care overnight. A group of stroke experts created a new map in record time
A group of medical professionals in masks look at a paper.

At 1 p.m., eastern time, on Tuesday April 7, about two dozen Canadian stroke experts dialled into a conference call as they do every two months. The meeting was organized by Dr. Patrice Lindsay, director of systems change and the stroke program at Heart & Stroke; the group was the Canadian Stroke Best Practices Advisory Committee.

Normally, they would be discussing responses to the group’s latest recommendations around acetylsalicylic acid (ASA) and stroke rehabilitation, as well as progress on updating other sections of the Canadian Stroke Best Practices Recommendations. Typically these updates take up to a year to conceptualize, write, edit and publish.

Instead, COVID-19 talk dominated. And precisely, how the team could create a statement to help healthcare providers deliver stroke care during a pandemic. The need was urgent. The ambitious proposed timeline: two weeks.

“One week from concept to publishing is a bit insane,” admits Patrice, a registered nurse with a PhD in healthcare performance, evaluation and outcomes.

But the medical community needed immediate support. That’s why the Canadian Stroke Best Practices Recommendations (supported by Heart & Stroke donors) exist: To help healthcare providers deliver the best care to stroke patients across the country, based on the latest scientific evidence and expert opinion.

Health care transformed

“The entire healthcare machine is being retooled because of COVID-19,” says Dalhousie University physiatrist and stroke rehabilitation specialist Dr. Anita Mountain, co-chair of the committee. The team shared insights into how the virus had impacted everything from prevention to acute stroke treatments. Seven members volunteered to write.

The idea for the statement had been hatched beforehand, via emails between Patrice, Anita and the other co-chair, Dr. Eric Smith, of the Hotchkiss Brain Institute at the University of Calgary.

Dr. Patrice Lindsay

We have an amazing group of volunteers who are so dedicated and passionate.

Dr. Patrice Lindsay Heart & Stroke

 

The timing was right. “When the world turned upside down in early March, we didn’t have very much to go by,” recalls Patrice. “We always pride ourselves in being responsive and looking to the evidence, and there was none.” By early April, studies out of Europe and Asia offered more reliable information — for example, emphasizing that some aspects of neurological assessments for suspected strokes can be done via telemedicine.

Everyone got to work. In Toronto, Patrice contacted Dr. Robert Chen, editor of the Canadian Journal of Neurological Sciences. He replied that he was interested in publishing the statement, and asked to see an early draft. Keeping in touch with the seven authors made for a hectic week for Patrice who was, among other things, helping run a series of webinars for Heart & Stroke. But the writing team kept her motivated. “I’m one of those geeky people that thrives on projects like this. I found it quite energizing.

Experts tackled different topics

In Calgary, Eric wrote most of his section on hyperacute (urgent) care by Wednesday night — as lead author, he needed to free himself up for editing. He was hopeful he’d have fewer meetings on his agenda. “But for every meeting that was cancelled, they seemed to add two more,” he quips.

He had much to write about: making sure patients understand stroke is still an emergency that needs timely treatment, setting criteria for intubating stroke patients during endovascular thrombectomy procedures, and protecting medical staff from the virus. “Stroke teams are small. If we lose a few people, that could seriously compromise care,” says Eric.

In Halifax, Anita was grateful she’d been compiling data for weeks. Since she was seeing some of her patients virtually, she had a bit more time some days — but not much. She wrote about the numerous new challenges for rehabilitation teams, including stroke patients being discharged from hospital earlier than normal, and helping patients recover while physical distancing.

A long weekend marathon

As that week slid into the Easter long weekend, the key team members settled in for a marathon of reviewing, revising and trimming, using shared Dropbox folders and sending documents via email.

On Sunday morning, Eric organized an Easter egg hunt for his children, then the family did a Zoom call with his parents. Then he went back to work. Patrice prepped a turkey and got it into the oven and was back at her computer while her husband and daughter whipped up the side dishes. Anita works out of her kitchen and multitasked all day. She prepared a turkey dinner for herself, her husband and son, and also dropped off portions to her elderly mother and to her stepdaughter and her partner. “All those other things don’t stop,” says Anita.

On Tuesday, April 14, just one week after the team hit start, Patrice sent a near final draft to the journal and Dr. Chen gave it the thumbs up. The following Sunday, April 19, it was published online by the journal, and also went live on the Stroke Best Practices website.

Positive feedback

Patrice has heard positive feedback from across the country about the statement. It helps professionals feel more confident about their treatment plans, and they can reference it when advocating for resources with administrators.

And for the committee, it also revealed what they can accomplish under pressure. “It showed us how nimble we can be,” Patrice says. “We have an amazing group of volunteers who are so dedicated and passionate about providing people in Canada with world-class stroke care.

Related information

 

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