Quality Improvement Research and Academic Focus

Quality improvement in hyper-acute stroke care: - seeking interested students and trainees in the below topics; if you are looking to collaborate or start an academic project please get in touch [houman {at} neurovascular.ca]. Current projects include:

  • Crisis Resource Management and Simulation in Code Stroke, Collaboration between ED and Stroke Neurology - Co-leads: Dr. Khosravani (stroke) and Dr. Kester-Greene (ED)
    • we run 4 or more joint ED-Stroke Simulations per year, focusing on CRM, and improving the quality of care for hyperacute stroke care via simulation
    • PGY 1s - Pre-residency start stroke simulation
      • 2021
      • 2022
      • 2023, NICE (Neurovascular Innovations CollaborativE), Drs. Khosravani and Hawkes
    • Joint ED (Dr. Kester-Greene) - Stroke (Dr. Khosravani) Simulations
      • Every 3-4 months, applying CRM in stroke care
  • NICE, the Neurovascular Innovations CollaborativE (NICE), Dr. Khosravani and Dr. Hawkes (co-founders)
  • StrokeFM Podcast - Official CSC (Canadian Stroke Consortium) Podcast
  • ML4QI, Computational QI, Machine learning as applied to quality improvement in stroke
    • 2024-2025 (academic years)
      • Lab Members:
        • Rishit Dagli, Computer Science, U of T, T-CAIREM (2024 student award)
        • Dr. A. Balachandar, Neurology, U of T, PGY5/Fellow(pursuing PhD in movement disorders and DBS) Project, ML4QI in Stroke
        • R. Saab, U of T Med, ML4QI in Stroke, Sunnybrook Research Institute
        • E. Nashnoush, MSc, U of T Data Science, ML4QI in Stroke, Sunnybrook Research Institute, T-CAIREM, HealthQuality
        • H. Mahdi, Western University, Med, ML4QI in Stroke
        • Dr. E. Adegunna, Neurology, U of T, PGY2/3
        • Dr. B. Tilley, Neurology, U of T, PGY1/2
        • Diya Ahmed, U of T Medicine
    • 2023-2024
      • Lab Members:
        • Dr. A. Balachandar, Neurology, U of T, PGY4/5 Project, ML4QI in Stroke
        • R. Saab, U of T Med, ML4QI in Stroke, Sunnybrook Research Institute
        • E. Nashnoush, MSc, U of T Data Science, ML4QI in Stroke, Sunnybrook Research Institute, T-CAIREM (2023 student award)
        • H. Mahdi, Western University, Med, ML4QI in Stroke, Sunnybrook Research Institute
        • Dr. B. Sivanandan, Neurology, U of T, PGY4/5 Project, Palliative Care in Stroke
        • Dr. M. Mahendiran, U of T, Family Medicine (graduated), Palliative Care research, Hospital Medicine Fellow (Orange Team)
        • Dr. E. Adegunna, Neurology, U of T, PGY2
        • Dr. B. Tilley, Neurology, U of T, PGY1
        • Diya Ahmed, U of T Medicine
    • 2022-2023
      • Lab Members:
        • Dr. A. Balachandar, Neurology, U of T
        • R. Saab, U of T Med, T-CAIREM (2022 student award)
        • M. Panchal, U of T Med, CREMS
  • Stroke and Thromobsis
    • We have a collaborative group on thrombosis, and we are full members of Thrombosis Canada.
    • Enhanced integration of thrombosis fellowship into stroke training and vice-versa
    • Local and National Innitative on Thrombosis in Stroke
      • Dr. Larry Robinson, Dr. Bill Geerts, and Dr. Khosravani, with a larger collaborative group.

  • New Onset Refractory Status Epilepticus

    • Neurocritical care EEG - status epileptius, refractory SE, NORSE
    • Interface between computational solutions and medical challenges in caring for acute medically-ill and critically-ill patients. My specific interest, based on my PhD work, is time-series analysis and utilizing both linear and nonlinear tools to analyze physiologic signals for classifying and predicting disease processes.

NQIL the Neurology Quality and Innovation Lab

Advocacy for better outcomes in NORSE

NORSE (New Onset Refractory Status Epilepticus) - NORSEINSTITUTE.ORG

Serving as a member of the Advisory Board at the NORSE Institute. We are a group of individuals spanning families, physicians (Pediatric & Adult Neurology, Neurocritical Care) dedicated to raising awareness for NORSE. We are building a foundation where other providers are able to diagnose, treat, and seek consultation from expert and expert-centers when managing NORSE patients. In addition, we have developed a registry for these pateints and soon their families. Our goal is to raise awareness of NORSE and associated conditions and to work toward a cure.

Vision of the NORSE Institute:

“Effective treatment for this rare and poorly understood disorder is currently elusive. Finding it requires new thinking from multiple medical disciplines and integration of these ideas and research. We hope to stimulate this thinking and explore both the conceptual boundaries of NORSE as well as the practical boundaries of NORSE treatment: long-term critical care, ICU and epilepsy coordination, palliative care, and immune treatments.”

Previous initiatives and completed projects

The following projects were aimed at quality improvement and education.

Door-to-Needle/Door-to-Intervention quality improvement project

  • Winner of our institution’s QI project 2019 - we have put into practice a durable process for QI in hyperacute stroke with a multidisciplinary and collaborative team, with our colleagues in our departments as stakeholders.
  • Stroke and quality of care/improvement in stroke pathways; specifically peri-thrombolysis and EVT, and critical care interaction
  • Collaborative project with multiple members of the stroke program and the regional stroke program where we have improved the door to needle time at our local center, with change ideas that are focused on human factors, checklists, and direct to CT scanner, with measurable and durable improvements and/or intervention time.
  • This work continues but the key ingredients are in place and showing durable benefit.

Medical Education – torontocriticalcare.org - Sr Resident and Fellow education in the intensive care unit at University of Toronto

Based on positive reception and uptake by users at Western and the increasing utilization of mobile devices for content consumption in medical education (and life in general!), we developed the Educational portal for the Interdepartmental Division of Critical Care at the University of Toronto. This website is being used by ICU Sr residents and clinical fellows for educational use and organization of the program.

Extubation Pathway – extubate

There are many excellent airway management strategies, checklists, and guidelines. The same cannot be said about extubation pathways and preparedness for acute extubation failure in general medical/surgical ICUs. I am working with Dr. John Fuller at Western University where we have developed and evidence-informed extubation pathway that can be utilized by Respiratory Therapists to assist in safe extubation practices. We are studying extubation safety pre- and post- pathway introduction to assess its impact on aspects of patient safety.

Medical Education – [eCriticalCare.org] - Junior/off-service resident education in the intensive care unit at Western University

For a full description of this project, please see eCriticalCare.org (see Education and ICU Boot Camp). The ICU rotation for junior and off-service residents can be challenging in many ways. These include: ICU as a complex environment with multiple teams and multi-modal monitoring, there are competing schedules (call,vacation,teaching schedules), there are different knowledge gaps and starting points for the residents, and there is significant anxiety associated with managing acute situations and procedures. We developed ICU Boot Camp as a course and mobile-platform using Google Classroom for students so that they can start their rotation ready to start taking care of critically-ill patients.