WSO - April 2023 - 379

A commitment to continuous improvement
and teamwork that goes all the way to the
top have made this Durban-based centre of
excellence the first private hospital in South
Africa to win a WSO Angels Award.
Switching roles for a simulation workshop with Angels.
A formal partnership with Angels in
2018 marked the start of a structured
programme to improve its stroke care by
means of training and protocol revision,
and from March 2022 this programme
was pursued with fresh vigour. The
stroke committee was formed in July. In
September, a team comprised of Dr Nilesh
Patel, Deena Naidoo, Samantha Hall and
Samantha Myles went on a field visit to
Steve Biko Academic Hospital in Pretoria,
the first hospital in South Africa to win a
WSO Angels diamond award largely thanks
to the ingenuity of neurologist Dr Louis
Kroon.
The real game changers however have
been two actions that directly impacted
the stroke pathway by identifying
opportunities for improvement. One was a
recent simulation that delivered consensus
around commencing thrombolysis at CT,
and the second an earlier decision to
capture their patient data in the stroke
care quality improvement registry, RES-Q,
through which they became eligible for a
WSO Angels Award.
As a hospital group that positions itself
as a provider of market-leading clinical
outcomes, Lenmed's leaders are fluent in
the language of data-driven improvement.
Lenmed Group Clinical Governance
Manager, Deena Naidoo, recites stroke
data for January to October 2022 as if
from memory: 198 cases were registered
in RES-Q, of which 99 were TIAs, 35
stroke mimics and 39 ischaemic strokes,
along with 8 cases of subarachnoid
haemorrhage and 3 of cerebral veinous
thrombosis. Samantha Myles, the clinical
programme coordinator who is responsible
for the on-the-ground management of
the stroke programme, has performance
metrics at her fingertips: since partnering
with Angels, her hospital has reduced
its median door-to-needle time from
80 minutes to 27, and almost tripled its
recanalization rate from 14,3 to 33 percent.
These are numbers far exceeding the
requirements for the gold award that put
the team on the stage at in Johannesburg
this December. They already feel like a
diamond hospital and are determined
to make it official - an ambition that is
supported by the integration of evidencebased
guidelines into routine hospital
practice and adherence to all but one
of the key priority actions identified by
Angels.
Pre-notified is standard, following which
the team is rallied via a stroke alert
Whatsapp group. Although the patient
isn't delivered directly to CT, they spend a
maximum of 15 minutes in the emergency
department, where point-of-care testing
is available for glucose and INR. Once the
therapeutic decision is taken, treatment
commences at CT. But the strongest signal
yet that this hospital will continue its
improvement journey is that it has created
a culture and systems that enable it to
learn from mistakes.
The stroke committee meeting is an
opportunity for feedback and learning,
Niresh says.
On the agenda is a case review for which
they select a patient with the most gaps
in their journey, in order to impact future
performance.
The same learning focus determines the
agenda of the weekly multidisciplinary
meeting attended by neurologists, allied
specialists and the nursing team, and
coordinated by Samantha Myles. There is
nothing punitive about these case reviews.
Instead, the foundation is set for future
success by creating a safe zone where
failure is a teacher.
At Lenmed Ethekwini Hospital and Heart
Centre, improvement is the goal and
teamwork the key, but it's the willingness
to scrutinise their own performance that
truly makes them stand out. As Niresh
Bechan says,
Every opportunity is
used to learn to be
better and do better.
The team from Lenmed Ethekwini Hospital and Heart Centre
were presented with their ESO Angels Award at South African Angels Day in December.
SPONSORED FEATURE I LENMED ETHEKWINI HOSPITAL AND HEART CENTRE LEADS THE WAY
Lenmed Ethekwini Hospital and
Heart Centre Leads The Way
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WSO - April 2023

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