Fortis Hospital Noida is situated in the state of Uttar Pradesh, which is adjacent to East Delhi, also known as Trans Yamuna, an administrative district of the National Capital Territory (NCT) of Delhi, India. According to the 2011 census, East Delhi is home to a diverse population of over 1,7 million people. It shares a boundary with Uttar Pradesh, one of the most populated states of India.
One of 28 hospitals in the Fortis Hospital Network, Fortis Hospital Noida is a comprehensive centre with the capacity to treat a large number of stroke patients. Over the course of 15 years, it has earned the trust of the population in the district. The vision of its neurology department is to provide compassionate patient care along with clinical excellence, with the goal of “Saving and Enriching Lives”.
Angels consultant Dr Tarun Gautam reached out to this hospital in 2019. He did an initial observation and held an orientation meeting with key stakeholders to understand their challenges and expectations. Plans for a simulation and debriefing meeting were agreed, and in early 2020 the hospital registered on the Angels website under the leadership of the Director of Neurology, Dr Jyoti Bala Sharma.
It was a good beginning, but nature had other ideas. When the pandemic and lockdown put a full stop to all our plans, the Angels team went to work on the principle that when you’re not hunting you should sharpen your axe. We established virtual contact with the hospital and commenced a programme of online training, enrolling 135 healthcare professionals including 77 nurses on the Angels website. Despite the disruption caused by the pandemic, 60 nurses from Fortis Hospital Noida obtained stroke nurse certification.
Slowly, the sun began to rise again. The Covid pandemic receded and a new world waited with open arms to embrace a new future. In February 2021, the Angels team revisited Fortis Hospital Noida and picked up where we had left off. Despite lingering fear and uncertainty, our first simulation was planned for 24 กุมภาพันธ์ 2564. The response was overwhelming – as if this was the most anticipated meeting ever between humans.
The simulation report showed that the Fortis team had achieved a door-to-treatment (DTT) time of 50 minutes. Although everyone was happy about achieving a time below 60 minutes, Dr Jyoti was not satisfied. A perfectionist who always does her best, she wanted to reduce their DTT time even further. For the sake of the large number of stroke patients treated at her hospital, Dr Jyoti wanted to make stroke care quality a priority. Plus her department wanted to live up to their vision and reputation for excellence.
During a joint brainstorming session, the stroke team along with Dr Jyoti and Angels studied the simulation debriefing and the parameters provided by RES-Q with the aim of identifying pathway delays. The team undertook to use Angels tools including checklists, the stroke bag and Helsinki poster to raise the standard of treatment, and under Dr Jyoti’s leadership committed to implementation with zero deviation. To reach the agreed objective of a DTT of 25 minutes, the team would receive training that included the hyperacute pathway, WOW CT and NIHSS, with the next evaluation due after six months.
With everyone aligned with a common objective, and goals and consensus in place, the Fortis team started collecting their stroke patient data in order to gather evidence of precisely which areas they needed to improve. Success arrived promptly, as Fortis Hospital Noida received their first WSO Angels diamond award for Q1 of 2021.
The second wave of Covid-19 brought more lessons. The hospital received an increased number of acute stroke patients and thanks to robust Covid screening the stroke team witnessed a reduction in the average DTT time to 25 minutes. The rate of recanalization increased as did the number of mechanical thrombectomies, which helped save critical lives. The upgraded protocol and data monitoring on RES-Q were delivering results.
Further analysis showed there was room for improvement in post-acute care, specifically with regards to dysphagia screening. With training and the help of neurology coordinator Mrs Athira Hareendran, screening by nursing officers on duty lead to better outcomes post thrombolysis in acute stroke patients.
As a preventive measure, emphasis was placed on counselling chronic patients in the cardiac department about BEFAST. This would in turn lead to more patients reaching hospital within the treatment window and more lives being saved.
Change is inevitable for us as well for the hospital, but our legacy at Fortis Hospital Noida continues. Since Dr Tarun became team leader for North and East India, Angels consultant Deepti Sawhney has continued working with the hospital and thanks to knowledge sharing, protocol compliance and continuous monitoring and improvement, Fortis hospital has reached diamond status eight times since 2020.
It is now time to look forward. With the new 100 Angels Regions strategy in place, there’s an opportunity to use the expertise at Fortis Hospital Noida on a wider stage. Under discussion is a hub and spoke model involving the peripheral hospitals that are the first referral points for stroke patients. The aim is to reduce inter-hospital delays to ensure more patients reach treatment in time. Together, we can give life a second chance!
