THE city of Novi Ligure is the seat of numerous noble palaces, one of the most famous chocolate factories in Italy and a cycling museum. It also has something no other city in the Piemonte region can claim – a diamond hospital, recognised for its excellence in stroke care. The palaces have been there for centuries, but the diamond award is still very new.
Just a year ago, Novi Ligure Hospital had a very different story to tell. As was the case at many hospitals across Europe during the pandemic, its neurology department and stroke unit had become Covid wards. Once the crisis abated, its neurology department was restored and a new stroke unit donated by the Lions Club in Novi Ligure. But after a period of having to manage stroke along less organised paths, their door-to-needle time had slipped to 76 minutes.
On her first visit to Novi Ligure in the summer of 2021, Angels consultant Elisa Salvati found much that needed improvement. The pathway was disorganised, prenotification was rare and after the treatment decision was made at CT, patients were transferred to the stroke unit for treatment to commence. But she also found a bright spot in the highly motivated head of neurology Dr Eugenia Rota and the medical director of the stroke unit Dr Gianluca Bruzzone, who had reached out to Angels and welcomed change.
Dr Rota says: "We knew what Angels were doing to improve stroke care in Italy and around the world and decided to take advantage of their programme to improve our performance."
The intervention in Novi Ligure kicked off with a multi-disciplinary meeting that brought together everyone involved in caring for stroke patients. From the ambulance service and emergency physicians to neurologists, radiologists and stroke nurses, everyone put their heads together to reconstruct the stroke pathway and agree on goals and an action plan.
The meeting took several important decisions. There would be a renewed focus on prenotification. The stroke team would record treatment data in the quality improvement registry SITS-QR and review cases in weekly meetings. The short-term goal was to treat all patients in under 60 minutes.
One decision would take a little longer to implement, but it was also the most important one.
Dr Rota explains: “The whole team had agreed to join the Treat at CT project of the Italian Stroke Association. Treating stroke patients at CT was to be our main ameliorative action.”
A pathway simulation in early spring would be the deciding factor. A door- to-needle time of 38 minutes achieved during the simulation sent the team’s confidence soaring and made a solid case for treating at CT.
Dr Rota describes the pathway that has taken Novi Ligure Hospital from under- performer to diamond award winner in under eight months.
“The neurologist waits for the patient’s arrival in the emergency room and directly accompanies them to the CT where the stroke unit nurse is present with the Angels stroke bag. Once the treatment decision is made, the stroke nurse administers the thrombolytic at CT while the radiology nurse performs a CT angiography if indicated.
“A lot of time is saved by not moving the patient down corridors or waiting for a porter or the lift. And instead of going back to the emergency room after the CT scan, once treatment has commenced the patient is transferred directly to the stroke unit, freeing up time for the management of other emergencies.”
The new pathway along with multi- disciplinary teamwork and Angels support has delivered exceptional results. With 100% of eligible patients now receiving therapy within 45 minutes of arriving at the hospital, Novi Ligure easily met the criteria for an ESO Angels diamond award, becoming only the 11th hospital in Italy and the first in Piemonte to reach this status.
Proud though they are of this achievement, Drs Rota and Bruzzone, head nurse Mrs Claudia Debenedetti and their team are already pursuing a new goal. They say: “Our team has committed to introducing the FAST Heroes project in our schools in order to raise awareness among the citizens of Novi Ligure and improve the prehospital stroke pathway. This is our next challenge, which we will push towards with the support of Angels and the Lions Club of Novi.”
Until recently Elisa has counted on Piemonte’s three gold award winning hospitals to inspire other teams in the region but Novi Ligure has raised that bar. There will be even more cause for celebration if their story encourages other hospitals to join them in the fast lane to success.