Spotlight on: Dr. Devin Harris
December 1, 2014
ICVHealth Clinical Lead
Assistant Professor in the Department of Emergency Medicine at UBC
Associate Director of Research, Interior Health
Staff Emergency Physician at Kelowna General Hospital
Medical Advisor for Stroke Services BC, PHSA
Stroke/TIA clinical lead, B.C. Patient Safety and Quality Council
December 1, 2014
Emergency Department management of patients with transient ischemic attack (TIA) and stroke
Stroke health services research
What first inspired you to become involved in this field?
During emergency residency training, Dr. Harris was required to choose a topic to present at grand rounds as part of his residency project. He found that everything in acute care in the emergency department was very time-sensitive and had a lot of evidence. Conversely, care options for stroke seemed to be limited. This lack of information inspired Dr. Harris to focus his studies on the issue, which led to a research fellowship on stroke in the emergency department with a focus on TIA care.
“During residency I thought, ‘There must be something we can do that actually improves care for stroke patients,’ so I undertook an initial project to look at thrombolysis for acute ischemic stroke – it wasn’t completely adopted into emergency back in the early 2000s… and that’s where [my involvement] stems from.”
What interests you most about this particular field in cerebrovascular care and outcomes?
Dr. Harris notes that the field of cerebrovascular care and outcomes is still in its ‘teens’ as far as its development as a research program. Cardiovascular research, on the other hand, is very mature and its evidence is substantial and significant due to the use of large randomized trials. Stroke is a large health care burden as it is the number one cause of adult disability in Canada, number two cause of dementia, number three cause of death, and one of largest consumers of health care dollars. Research in this field is thus full of potential.
“Cerebrovascular literature is still developing… it still requires a fair bit of generation of evidence to be able to fill in the gaps for a lot of what we don’t know. So I think with stroke it’s extremely exciting just because there is a whole bunch of opportunity in stroke research to be able to show an improved care for stroke patients and prevent stroke overall.”
How do you envision your role contributing to ICVHealth?
Dr. Harris believes that his role within ICVHealth is ultimately a partnership and leverage role.
“The potential with [ICVHealth] is the fact that it has a provincial mandate, has expertise from a population health standpoint, and has a focus on research plus improvement in provision of healthcare.”
Being the stroke clinical lead for ICVHealth allows Dr. Harris to access the centre’s areas of overlapping expertise to leverage and improve care for stroke and TIA patients.
Tell us one potential strategy that you envision improving cardiovascular care in BC/Canada.
According to Dr. Harris, the largest movement for improvement of cerebral and cardiovascular health involves a focus on upstream care. The upstream care initiative for stroke recognizes TIA as extremely high risk and advocates intervening after TIA as a significant way to reduce short-term risks of stroke. In keeping with the ICVHealth mandate, upstream care also focuses on generating evidence to improve the prevention of stroke in people who have atrial fibrillation (AF) or undiagnosed AF. If you have an AF-induced stroke, you have the highest mortality and highest risk of disability. Dr. Harris believes that if research can identify those with AF and prevent them from having a stroke, it will significantly reduce patient death, disability, and costs to the health care system.
“We do a very strong job at acute care in hospitals… but if we can prevent heart attacks and strokes from occurring in the first place, then we’re not going to need to have such a huge infrastructure in patient care for people with heart attacks and stroke.”
I see you are involved with knowledge translation and invested in changing the efficiency and quality of our health care system. What do you personally want to change, and why?
Dr. Harris reiterates that one of the key points in stroke prevention is the recognition of TIA as extremely high-risk. The current cultural idea is that once you are admitted for TIA, you will get better and you will then leave the hospital. Dr. Harris says that culture is taking a while to catch up to current evidence, which advocates an alternative preventative method of care. Both health care providers and the public are slowly becoming more aware that TIA is a very time-sensitive issue and should be dealt with accordingly.
“My push is that [TIA cases] should all be managed within emergency departments… the largest thing for management of TIA is access to imaging and investigations… [Patients] should at least initially be seen in the emergency department, just as you would see someone who has chest pain or unstable angina.”
With respect to your field of research, are there any common myths or misconceptions many believe in?
“80% of all strokes are preventable. So the thought that stroke is inevitable is a misconception.”
By modifying five risk factors, you can reduce the risk of stroke by 80%. Dr. Harris lists the five factors as follows: (1) hypertension, (2) healthy diet, (3) exercise, (4) smoking, and (5) obesity.
Is there anything else you think is important to address with respect to stroke and TIA?
Dr. Harris believes that care providers and researchers are investing a lot of time and effort in stroke care research and providing information that may be therapeutic, but the public also needs to be made aware of the signs and4symptoms of stroke.
“[People] can make significant steps towards reducing their risk of stroke, and when they or a family member have symptoms or signs of stroke they should seek medical care right away – and that means calling 911.”
Are there any favourite sports or hobbies you engage in?
Dr. Harris enjoys playing hockey in his spare time.