News

Dr. Noreen Kamal is working to improve outcomes for stroke patients across Canada. A professor in Dalhousie’s Department of Industrial Engineering, she’s used to people finding the focus of her work unusual. “I do get it a lot. ‘You’re in engineering and you do health care? That’s so weird.’”

Dr. Kamal is the principal investigator for OPTIMISING ACCESS, a national initiative that aims to ensure the highest level of quality in acute stroke treatment across Canada.

Stroke is the leading cause of severe disability in adults, and one of Canada’s top killers. EVT (endovascular therapy) is a highly effective treatment, but it is only available in large centres and must be administered quickly. OPTIMISING ACCESS will build a national stroke registry, use the data to assess rural-urban disparities when it comes to EVT access, and then move on to a national project to improve transfer efficiency.

“In stroke, we lose 1.9 million neurons every single minute,” Dr. Kamal says. Administering EVT quickly can mean the difference between minimal brain damage and severe disability or death. But the procedure can’t be done just anywhere. She says, “You need an angio suite and interventional neuroradiologists to perform these procedures” — and those are typically only found in larger cities and teaching hospitals. 

Currently, EVT is only available at 27 hospitals in Canada. The majority of patients arrive at one of the country’s 178 primary stroke centres, which offer thrombolysis treatment, but not EVT.  They may then get transferred to one where EVT is available.

As Dr. Kamal explains, “Something like 30 to 50 percent get the procedure, and the remainder arrive too late. So it creates this huge disparity between urban and rural patients in this country.” 

She says the answer is not to make EVT available everywhere — that would mean putting neuroradiologists in small communities where they might only do the procedure a few times a year. Instead, she hopes to help lower the time between stroke patients arriving at a primary stroke centre, and when they leave for an EVT hospital. That’s called door-in-door-out-time.

This is not Dr. Kamal’s first large-scale project aimed at improving stroke care.  After completing her PhD at UBC, she joined the internationally renowned Calgary Stroke Program. There, she led a project to reduce “door to needle time” — the time from arrival in hospital to the start of thrombolysis treatment. “I worked with all 17 of their stroke centres, and we brought it down from approximately 70 minutes to 39 minutes. So, a huge reduction in time to treatment,” she says. She also learned  “a lot about how to implement change and how to make change across organizations.”

That experience will inform her work with OPTIMISING ACCESS, where the goal is to reduce door-in door-out time across Canada. “Currently we're sitting at something like two hours, and we want to bring it down to 45 minutes.” That may seem ambitious, but the Alberta experience shows it’s possible.

While her research involves working closely with medical staff, Dr. Kamal says it’s her engineering background that has primed her for success in quality improvement — even if she didn’t recognize it right away. Her attitude was, “I’m an engineer! I want build new technology, I don’t just want to be improving processes.” But Dr. Kamal says she quickly “got the quality improvement bug. I loved it. As an engineer, we think differently than clinicians, right? We're systems thinkers.”