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Indonesia

Murni Teguh Memorial Hospital’s Journey To Diamond Status

The initial goal at this hospital in North Sumatra was to reduce their door-to-needle time to below 60 minutes. It took them just six months to reach an average door-to-needle time of 19 minutes and win the first of two WSO Angels diamond awards.
Angels team 14 March 2023

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MURNI TEGUH Memorial Hospital’s journey to diamond status got underway in February 2022 when Angels consultant Immaculata Titis Winiati met with the hospital CEO, Dr. dr. Mutiara, MHA, MKT. The hospital management team gave its support to a collaboration with the Angels Initiative with the goals of raising the standard of stroke care and saving more lives.

Less than six months later, Muri Teguh Memorial Hospital became the first hospital in North Sumatra to win a WSO Angels diamond award and only the fifth hospital in Indonesia to achieve this status.

If you ask neurologist Prof. dr. Kiking Ritarwan, Sp.S(K), MKT about the reasons for this extraordinary accomplishment, he answers with two words – persistence and continuity. Add to these the qualities of leadership, teamwork and ambition, and the story of stroke at Muri Teguh unfolds.

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Muri Teguh Memorial Hospital (MTMH) is a hospital in Medan, the capital of North Sumatra and the economic centre for the whole Sumatra island. Its stroke care improvement programme kicked off almost as soon as goals had been agreed, with training and pathway simulation conducted in collaboration with the Neurologist Association in March 2022. One of the main insights gleaned from this exercise was the value of taking stroke patients directly to CT.

Inspired by their initial improvement, the MTMH stroke team participated in several more simulations, with the goal of reducing their door-to-needle time from 75 minutes to below 60 minutes. They did not so much meet it as beat it, reducing their average door-to-needle time to a world-class 19 minutes!

During 2022, MTMH admitted more than 250 stroke patients. Thanks to a Code Stroke system implemented in the emergency room and inpatient room, a chatbot in WhatApp that activates prenotification, the commitment of the emergency services team, and a new streamlined stroke pathway, these patients could be quickly assessed, diagnosed and treated.

The expansive Heart & Stroke Emergency Centre provides a stroke ICU with 20 beds for specialist post-acute care that improves patient outcomes.

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To ignite the fire within the team, MTMH created a WhatsApp group to share pre- and post-treatment patient updates, an intervention that promotes a sense of urgency, and builds a comprehensive evaluation system with a “no blaming” culture.

This synergy also provides comprehensive two-way feedback between departments (EMS, Pharmacy, Radiology, Neurology) to maximize the learning process of the team. Education for nurses has not been overlooked. A stroke nurse certification workshop in collaboration with the Nursing Association and the Angels Initiative took place in August 2022.

Thanks to this commitment to learning and continous improvement, MTMH received their second WSO Angels diamond award for Q3 of 2022.

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There are still challenges to overcome. Knowledge of stroke and stroke symptoms among the people of Median city is low, which means that many patients who are brought to the MTMH emergency room are already outside the treatment window for thrombolysis. The hospital plans to extend its stroke treatment capacity to include mechanical thrombectomy and provide a comprehensive service for patients.

Joining the Angels Initiative has not only lead to significant improvement in stroke management at the hospital. It has also exposed the MTHM stroke team to a wealth of resources, opened their minds to new perspectives and positioned them as leaders in the field.

To increase public awareness, MTHM neurologists held a free public seminar on stroke in April 2022, and in September 2022 the Code Stroke Team was involved in a scientific webinar and workshop series on the topic ‘Heart & Stroke: Two in One Entity’. The hospital is also involved in the Medan stroke network initiated by the Neurologist Association, acting as a hub for the surrounding spoke hospitals in Medan city.

Stroke improvement is not a one-man show, the doctors at MTHM believe. For this reason they hope that their own achievements will have a ripple effect on the surrounding hospitals, so that stroke patients throughout North Sumatra will have a second chance at life.

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