Designing systems to build access to high-quality stroke treatments across Canada
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Designing systems to build access to high-quality stroke treatments across Canada
There is often a big difference in the quality of healthcare received by patients living in urban and rural areas, usually due to proximity to specialised hospitals. At Dalhousie University in Canada, Dr Noreen Kamal is aiming to change that, by putting her industrial engineering skills to use to improve a registry system that helps rural stroke patients get the same quality of care as urban dwellers, improving their chances of going on to live full lives.
Talk like an industrial engineer
Catheter — a flexible tube inserted into the body (and used for many medical procedures)
Endovascular thrombectomy (EVT) — a minimally invasive procedure used to remove a blood clot from a blocked artery in the brain, particularly for ischemic strokes
Haemorrhagic stroke — a type of stroke that occurs when a blood vessel in the brain ruptures
Ischemic stroke — a type of stroke that occurs when a blood clot restricts blood flow in the brain
Peripheral stroke centre — a local or community hospital that does not have capability to provide EVT, but does provide thrombolysis treatment (a medical treatment given intravenously to ischemic stroke patients)
Stentriever — a medical device used to remove a clot from an artery
A stroke is a sudden medical emergency caused by an interrupted flow of blood to the brain, which can lead to brain tissues being damaged or dying. “In the average stroke, 1.9 million neurons are lost every minute,” says Dr Noreen Kamal of Dalhousie University. “This makes it critical to get blood flowing in the brain again as fast as possible.” Strokes fall into two categories: ischemic strokes involve a blood clot in the brain, while haemorrhagic strokes involve a bleed in the brain. “Ischemic strokes account for around 85% of all strokes,” says Noreen. “Currently, about 15% of ischemic strokes can be treated using a procedure called an endovascular thrombectomy.”
An endovascular thrombectomy (EVT) involves threading a catheter into a main artery in the stroke patient’s groin, all the way to the clot in the brain. There, a specialised medical device called a stentriever pulls out the clot. “EVTs can be highly beneficial to patients with large strokes,” says Noreen. “The procedure means the difference between a patient going home with a positive outcome or the stroke resulting in a disability or death.” Noreen wants EVTs to become available to as many ischemic stroke patients as possible – and the OPTIMISING ACCESS registry her team is building aims to make this possible.
Building the registry
The OPTIMISING ACCESS registry will provide medical centres with detailed data on the processes and outcomes for stroke patients, helping healthcare providers to improve their own practices and to improve patient outcomes. “These data will include patient demographic data, like sex and age at time of stroke,” explains Noreen. “Other data will cover information about the stroke, such as when it occurred, its severity and all the critical time points in the first minutes and hours after the stroke.” The registry will also collect information about when key steps in the treatment process happened and the eventual outcomes for the patient.
Noreen aims for the registry to be used across all of Canada’s ten provinces and three territories, which currently have variable ways of managing patient data. “The registry provides a simple online data entry method, which involves filling in information from the patient record,” says Noreen. “Many provinces have stroke registries, so they will export the relevant data from their own registry and upload it into the OPTIMISING ACCESS registry.” Careful coordination is ensuring that data entry is not duplicated, reducing the impact on healthcare providers’ workload.
Analysing the registry’s data
Noreen’s team wants to ensure that the data collected are used as effectively as possible. “We have built data visualisation tools, so that sites and provinces can see how their performance compares against the average,” she says. “For example, the median ‘door-in-door-out’ time will be comparable with provincial and national performance, as will outcome measures.” Door-in-door-out time refers to the time between patients arriving at the first (peripheral) stroke hospital and them being sent to an EVT-capable centre – a critical period that can have huge implications for the health outcomes for patients. The sooner patients can receive EVT treatment, the better.
With these data in hand, medical centres can work to improve their handling for stroke patients. “The disparity in EVT access for stroke patients is because of the time dependence of the disease,” explains Noreen. “EVT is only available in large urban hospitals due to the expertise and equipment required. So, patients who arrive at other stroke centres – for example, in more rural areas – need to be transferred to hospitals capable of EVT quickly.”
Time is of the essence when dealing with stroke patients; with millions of neurons dying every minute, every moment counts. “Currently, many patients who are transferred from peripheral stroke centres (that do not have EVT equipment) to EVT-capable centres arrive too late –there is not enough brain tissue left to save,” says Noreen. “Average door-in-door-out time at these peripheral stroke centres is currently around two hours, and we want to reduce this to 45 minutes.” Insights from the OPTIMISING ACCESS registry can help medical staff make faster and better decisions to get these patients to vital treatment as quickly as possible.
Impacts so far
Reference
https://doi.org/10.33424/FUTURUM591
The OPTIMISING ACCESS project is still in its early stages, but successes are already beginning to stack up. “We’ve created a National Roundtable that includes a provincial health system administrator and stroke physician from each province and territory, as well as a patient representative,” says Noreen. “This roundtable creates a strong national voice to improve access to EVT and reduce the difference in healthcare provided to patients living in different areas.” The roundtable is supporting the team’s efforts in navigating the different requirements and approval processes across each province. “Right now, three provinces have approvals in place, including agreements on privacy, ethics and data sharing,” explains Noreen. “Five further provinces have started the approvals process, and we are in the process of determining the requirements of the remaining two provinces and the three territories.”
Once approvals are all in place, the next step for Noreen and the OPTIMISING ACCESS team is to populate the registry with data that covers a large enough geographical area to be able to assess disparity between rural and urban patients. “Once we have this covered, we will move to the improvement phase, where we will reduce door-in-door-out times for peripheral stroke centres,” says Noreen. This will have real impacts for stroke patients. People who otherwise might have died or suffered serious long-term health complications will be able to return to their normal lives, healthy and as physically able as before.
Noreen Kamal, P.Eng. Ph.D.
Associate Professor, The Health Care Optimization and Analytics Lab (H-COAL), Department of Industrial Engineering, Dalhousie University, Canada
Fields of research: Industrial engineering, health systems
Research project: Designing a unique registry to ensure the highest level of quality in the treatment of stroke patients across Canada
Funder: Natural Sciences and Engineering Research Council of Canada (NSERC)
Website: optimisingaccess.ca
About industrial engineering
Industrial engineering is a branch of engineering that focuses on optimising complex systems or processes. “While engineers make things, industrial engineers make things better,” says Noreen. “We’re big picture thinkers, viewing everything as an interconnected system.” Industrial engineering combines ideas from management and business, and mathematics, amongst many others.
While the name may suggest that industrial engineers work principally with industry, such as the manufacturing sector, their remit is actually much wider. Any part of society that depends on integrated systems will have industrial engineers working on it. “Industrial engineers do so many inspirational things for society,” explains Noreen. “The technology they work on can improve the environment, our healthcare system, urban planning and many other areas.”
Given that the field draws insights from so many different areas, interdisciplinary teamwork is essential. “It’s key to build strong relationships based on trust,” says Noreen. “It’s so rewarding when we can create a strong team with expertise in different areas, as team members’ various perspectives can elevate the project and everyone’s understanding of the issues involved.”
As technology and societal needs evolve, so does the field of industrial engineering. “I anticipate that supply chain management and data science, including artificial intelligence, will become very strong sectors for industrial engineers,” says Noreen. “There will also be a growing number of opportunities in healthcare, especially as the sector becomes more digitally integrated.” The emergence of a more systematic approach to healthcare, where improvements (like OPTIMISING ACCESS) target the health network as a whole, rather than individual medical centres, is opening up new opportunities for industrial engineers to use their skills.
Pathway from school to industrial engineering
Noreen recommends building a strong foundation in mathematics (including calculus), physics and chemistry at school. “Even if the connection of these subjects to industrial engineering is not clear while you study them in school, their application to the field will become clearer later on in your education and career pathway,” she says.
Studying a degree in industrial engineering is the most straightforward path to entering the field. However, related fields such as management, applied mathematics and computing can also lead to industrial engineering.
This video from students of the Industrial Engineering Department at Dalhousie University provides a fun introduction to what studying industrial engineering looks like.
Explore careers in industrial engineering
Noreen is part of the Improving Diversity in Engineering Across Nova Scotia programme, which runs two flagship initiatives aiming to make engineering more accessible for under-represented groups in the province of Nova Scotia. Find out more.
The Institute of Industrial & Systems Engineers has an accessible article on what it is like to have an industrial engineering career in healthcare.
Indeed provides some more information about careers in the field.
According to Indeed, an industrial engineer can expect to make an average of around $82,000 per year in Canada.
Meet Noreen
I excelled in maths and physics at high school, but I couldn’t see myself in engineering. I wanted to make an impact on society and was more interested in social sciences. I ended up studying engineering as my good friend chose the same field!
At university, I studied chemical engineering, as my university didn’t offer courses in industrial engineering. After my master’s degree, I worked for 13 years before starting my PhD in computer engineering.
I would say I’m an engineering generalist. After my master’s degree, I first worked as a consultant designing and implementing industrial process control systems. Although I enjoyed the work, I wanted to make a bigger contribution to society. This led me to work in healthcare. From here, I gained an interest in research and pursued my PhD studies.
I enjoy leading my own lab. It’s a wonderful way to make my students and staff feel like they are part of a community. We use lab meetings as a way to share our research, which is so important as conducting research can be a bit isolating.
I feel so fortunate to be teaching young industrial engineers and working to improve health systems. My biggest career achievement so far involves reducing ‘door-to-needle’ times in Alberta for ischemic stroke patients, improving the efficiency of the treatment they receive and their outcomes.
I’m committed to improving outcomes for stroke patients. I just want to keep doing what I’m doing, helping optimise the processes and systems that have such a big impact on patients’ lives.
Noreen’s top tip
Always know that you can make a difference. Never be afraid to make changes that will lead to improvements down the line.
Do you have a question for Noreen?
Write it in the comments box below and Noreen will get back to you. (Remember, researchers are very busy people, so you may have to wait a few days.)
How are strokes, dementia and depression linked?
www.futurumcareers.com/how-are-strokes-dementia-and-depression-linked
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