Stroke care during COVID-19

Training and new protocols helped boost safety and confidence

When the COVID-19 pandemic began, The Neuro’s stroke service had to immediately re-evaluate the way they provided care. Dr. Mohamed Badawy was one of those who took a leading role in overcoming this sometimes-overwhelming challenge.

Dr. Badawy found himself in an ideal position to direct the stroke unit’s pandemic response. As chief of anesthesia at The Neuro, a member of the neuro-ICU team, the RED Unit service (the receiving area for stroke patients), and The Neuro’s executive committee, he regularly interacts with leaders and representatives of each of the hospital departments and services. This allowed him to build a multi-disciplinary team to tackle the challenge of rethinking and rebuilding stroke care during the COVID-19 pandemic.

Early on in the pandemic, The Neuro was made a non-COVID hospital, meaning it would not be treating COVID patients, to be able to fulfill its mandate of providing highly specialized neurological care. If patients that are admitted test COVID-positive, they are transferred to a COVID-dedicated hospital as soon as possible after neurological treatment. But because the Red Unit provides emergency care, and patients cannot be screened for COVID-19 before they are brought there, the potential to receive patients infected with COVID-19 is real–that created unique challenges for Dr. Badawy and his colleagues.

“This was a major change in the way we practice,” he says. “Entirely new pathways and protocols had to be created from scratch to treat stroke patients who were potentially infected with COVID. You had this added layer of complexity. Everyone in the community now could be potentially COVID positive and we needed to figure out how to optimally treat patients with stroke while keeping everyone else in the hospital safe from COVID.”

Coordinating a response

Dr. Badawy helped coordinate the pandemic response, working with multiple departments and levels of hospital administration. They created negative pressure rooms where patients are intubated without risk of spreading COVID-19. As well, they created new protocols specifying that they intubate patients before they go into the operating room, to prevent contamination in the event the patient is COVID-positive.

To make sure everyone learned the new pathways, Dr. Badawy worked with his colleagues to organize simulation sessions to run through different scenarios using the new protocols. For those who could not do training in person because of scheduling, they made numerous videos so the trainees could watch the scenarios in their own time. A nurse with significant film-making experience recorded the training, worked on the editing and sent the educational short videos to the teams.

The multidisciplinary team then developed a list of every hospital staff member who would be near patients to train them all. This was a major undertaking as it included nurses, doctors, respiratory therapists, radiology technologists, and other professionals across many different teams. Every department of the hospital was involved.

“Anyone potentially exposed needed to be trained,” Dr. Badawy says. “It was a huge undertaking to round these people up to make sure they got the training or saw the video.”

The new protocols and training quickly paid off, as they did receive COVID-positive stroke patients who were quickly identified and transferred out shortly after being treated for stroke without contaminating health care workers or other patients.

More than that, Dr. Badawy says the training boosted everyone’s confidence and decreased anxiety among personel. The training came at a time when information about the virus was constantly changing and people did not know what to expect day to day. “There was a lot of fear among the staff,” he says. “They didn’t know what it meant for their practice and if the institution was putting in the right measures.”

“The training reassured people and made them feel more comfortable working with patients who were possibly infected. It showed that the hospital administration had this covered. It helped with team morale, so healthcare workers felt protected and didn’t feel overwhelmed.”

Dr. Badawy says this has been one of the greatest challenges of his career. He put his diverse set of skills to good use, coordinating and working in close collaboration with people across the hospital.

“I’m in unique position,” he says. “I wear many hats and I work in many different departments, seeing how they function. This bird’s eye view of the hospital allowed me to see what needed to be done to create a safe working environment and to implement the necessary changes by engaging all teams involved.”

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The Neuro is a McGill research and teaching institute; delivering high quality patient care, as part of the Neuroscience Mission of the McGill University Health Centre. We are proud to be a Killam Institution, supported by the Killam Trusts.

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