1stroke - a project in development, aims to be a transformative force in global stroke care from a QI perspective. The platform’s mission centers on elevating the quality of stroke care across healthcare institutions. 1stroke will enable benchmarking. More details are forthcoming - stay tuned!
References
2023
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Evaluating Barriers and Tools to Optimize Resident Call Scheduling on Neurology In-Patient Services (P8-7.006)
James Im, Charles Kassardjian, Houman Khosravani, and Sara Mitchell
Tuesday, April 25, 2023
2021
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Team debriefs during the COVID-19 pandemic in long-term care homes: Essential elements
Giulia-Anna Perri, Warren Harris Lewin, and Houman Khosravani
Canadian Family Physician, 2021
2020
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Protected Code Stroke: Hyperacute Stroke Management During the Coronavirus Disease 2019 (COVID-19) Pandemic.
Houman Khosravani, Phavalan Rajendram, Lowyl Notario, Martin G Chapman, and Bijoy K Menon
Stroke, 2020
Background and Purpose- Hyperacute assessment and management of patients with stroke, termed code stroke, is a time-sensitive and high-stakes clinical scenario. In the context of the current coronavirus disease 2019 (COVID-19) pandemic caused by the SARS-CoV-2 virus, the ability to deliver timely and efficacious care must be balanced with the risk of infectious exposure to the clinical team. Furthermore, rapid and effective stroke care remains paramount to achieve maximal functional recovery for those needing admission and to triage care appropriately for those who may be presenting with neurological symptoms but have an alternative diagnosis. Methods- Available resources, COVID-19-specific infection prevention and control recommendations, and expert consensus were used to identify clinical screening criteria for patients and provide the required nuanced considerations for the healthcare team, thereby modifying the conventional code stroke processes to achieve a protected designation. Results- A protected code stroke algorithm was developed. Features specific to prenotification and clinical status of the patient were used to define precode screening. These include primary infectious symptoms, clinical, and examination features. A focused framework was then developed with regard to a protected code stroke. We outline the specifics of personal protective equipment use and considerations thereof including aspects of crisis resource management impacting team role designation and human performance factors during a protected code stroke. Conclusions- We introduce the concept of a protected code stroke during a pandemic, as in the case of COVID-19, and provide a framework for key considerations including screening, personal protective equipment, and crisis resource management. These considerations and suggested algorithms can be utilized and adapted for local practice.
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Modification to Neurology Residency Training: The Toronto Neurology COVID-19 Pandemic Experience
Ryan T Muir, Priti Gros, Robert Ure, Sara B Mitchell, Charles D Kassardjian, Aaron Izenberg, Peter Tai, Houman Khosravani, and David K Chan
Neurology: Clinical Practice, 2020
We describe the University of Toronto Adult Neurology Residency Program’s early experiences with and response to the coronavirus disease 2019 pandemic, including modifications to the provision of neurologic care while upholding neurology education and safety. All academic and many patient-related activities were virtualized. This maintained physical distancing while creating a city-wide videoconference-based teaching curriculum, expanding the learning opportunities to trainees at all academic sites. Furthermore, we propose a novel split-team model to promote resident safety through physical distancing of teams and to establish a capacity to rapidly adapt to redeployment, service needs, and trainee illness. Finally, we developed a unique protected code stroke framework to safeguard staff and trainees during hyperacute stroke assessments in this pandemic. Our shared experiences highlight considerations for contingency planning, maintenance of education, sustainability of team members, and promotion of safe neurologic care. These interventions serve to promote trainee safety, wellness, and resiliency.
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Crisis Resource Management and High-Performing Teams in Hyperacute Stroke Care
Phavalan Rajendram, Lowyl Notario, Cliff Reid, Charles R Wira, Jose I Suarez, Scott D Weingart, and Houman Khosravani
Neurocritical Care, 2020
Management of stroke patients in the acute setting is a high-stakes task with several challenges including the need for rapid assessment and treatment, maintenance of high-performing team dynamics, management of cognitive load affecting providers, and factors impacting team communication. Crisis resource management (CRM) provides a framework to tackle these challenges and is well established in other resuscitative disciplines. The current Coronavirus Disease 2019 (COVID-19) pandemic has exposed a potential quality gap in emergency preparedness and the ability to adapt to emergency scenarios in real time. Available resources in the literature in other disciplines and expert consensus were used to identify key elements of CRM as they apply to acute stroke management. We outline essential ingredients of CRM as a means to mitigate nontechnical challenges providers face during acute stroke care. These strategies include situational awareness, triage and prioritization, mitigation of cognitive load, team member role clarity, communication, and debriefing. Incorporation of CRM along with simulation is an established tool in other resuscitative disciplines and can be incorporated into acute stroke care. As stroke care processes evolve during these trying times, the importance of consistent, safe, and efficacious care facilitated by CRM principles offers a unique avenue to alleviate human factors and support high-performing teams.