Atlantic Canada Together Enhancing Acute Stroke Treatment (ACTEAST): Improving Access and Efficiency of Treatment

Stroke is a devastating disease, as the leading cause of severe physical disability. Ischemic stroke is the most common form of stroke; and is treatable with medical treatment and a new minimally invasive surgical procedure. These treatments can transform lives, but minutes matter for improving outcomes. The research objectives are focused on increasing the proportion of ischemic stroke patients receiving treatment, and improving the efficiency of treatment. We will carry out this work across all of the Atlantic provinces. In Canada, healthcare is administered within provincial boundaries; this presents a particular challenge in Atlantic Canada due to small populations and the lack of locally available medical specialists. We aim to overcome these care barriers to ensure that all stroke patients have access to efficient treatment based on their clinical presentation, not on system restrictions. We will employ an Improvement Collaborative intervention. It has been used successfully in health care to implement improvements across multiple hospitals. This intervention uses the Model for Improvement adopted from Industrial Engineering, which employs alternating face-to-face workshops and action periods to test and implement changes at local hospitals. The workshops involve sharing information with hospital teams and facilitation of cross-site learning. Additionally, operations research in simulation will be employed to ensure that the health system can adequately support the changes. This research presents many challenges such as cross-provincial access and a novel trial design; however, the potential benefit for patients experiencing ischemic stroke is profound. It is anticipated that 10-20% of ischemic stroke patients will have improved outcomes, which means that up to 550 more patients each year in Atlantic Canada can return to their homes with no or little disability, and utilize much less rehabilitation and long-term care services.