3rd Annual Fraser Health Stroke SymposiumSheraton Guildford Hotel, Surrey Saturday, April 14, 2012

Regional Stroke Strategy

Session Objectives

1.

Identify Regional Stroke Strategy priorities

2.

Review access for TIA Clinics3.

Show key findings from 2011National Stroke Audit

Session Objectives

1.

Identify Regional Stroke Strategy priorities

2.

Review access for TIA Clinics3.

Show key findings from 2011National Stroke Audit

Regional Stroke Volumes ARH BUH CG

H

DH ERH FC

H

LMH MMH PAH RMH RCH SMH FHA

Hemmor hagic

32 45 20 14 14 1 36 10 43 18 57 47 337

Ischemic 134 161 105 62 77 11 147 25 139 83 246 235 1425

TIA 56 44 34 44 19 1 19 10 18 10 74 85 414

Total 222 250 159 120 110 13 202 45 200 111 377 367 2176

% 10% 11% 7% 6% 5% 1% 9% 2% 9% 5% 17% 17%

Regional Priorities• Acute Stroke Service• Bypass protocols• Improve tPA rates• Stroke Cohort Units

SMH (2009)RCH (2010)BGH (2011)ARH (2012)

Stroke Cohorts• CoCo--locating stroke patientslocating stroke patients• Nursing education enhanced• Care path and order sets updated• Electronic referral system• Reduce complications:

Skin breakdownDysphagia related pneumoniaIncontinenceVTE

Surrey Critical Care Tower

• 36 Bed Neurology Unit

• Acute Stroke Unit

Regional PrioritiesRehab services•REDI program – early supported discharge

Community Reintegration•STart program (Abbotsford) – transitions from acute to community

Regional PrioritiesStroke Education Workshops (2012)• 500 medicine seats• 250 rehab seats• 130 emergency seats

Online Learning Module (Hemispheres)• 100 seats for developing stroke champions

Session Objectives

1.

Identify Regional Stroke Strategy priorities

2.

Review access for TIA Clinics

3.

Show key findings from 2011National Stroke Audit

Fraser North RCH

Fraser EastARHCC

Fraser SouthSMH

2000+Patients seen in

past 12 months

Referral Process• Faxed referral form

Brief historyDate/time onsetABCD2 score

• Labs and diagnostics• Consult reports• Patient called directly

STROKE PREVENTION CLINICFHA Physician Referral

Patient Name: D.O.B.: PHN: Phone (Home): Phone (Cell): Address:

Note: Coloured lines and text do not appear on final form.

Clinic Location Requested: □ Surrey Memorial Hospital □ Royal Columbian Hospital □ ARHCC □ Any Site Referring Physician: _____________________________ Phone #: _______________________

Physician Billing #: _________________________

PHYSICIAN: PLEASE COMPLETE ALL SECTIONS

1. CLINICAL FEATURES: □ First Episode □ Recurrent Episodes

Date/Time of onset : ________________________ / _____________ Reason for Referral: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

2. RISK STRATIFICATION for EARLY STROKE

ABCD² Scoring POINTS Age ≥ 60 years old 1 Blood Pressure Systolic ≥140 mm Hg and/or Diastolic ≥ 90 mm Hg 1

Unilateral weakness 2 Speech disturbance without weakness 1

Clinical Features

Other 0 ≥ 60 minutes 2 10-59 minutes 1

Duration of Symptoms

< 10 minutes 0 Diabetes Diabetes Mellitus 1

TOTAL SCORE

Score 2-Day Risk of Stroke Risk Target Referral Time 0 - 3 1% Low Risk 48 to 72 hours 4 - 5 4.1% Higher Risk 24 to 48 hours 6 - 7 8.1% Consider Admission Immediate

3. INVESTIGATIONS ORDERED: □ CT Head/CT Angio □ ECG □ Echocardiogram □ Carotid Ultrasound

□ Other (s): _________________ / _____________________ 4. MEDICATIONS PRESCRIBED:

Enteric Coated ASA 81 mg daily Clopidogrel 75 mg daily (requires Special Authority

from Pharmacare)

ASA-Dipyridamole (Aggrenox) one capsule BID Other _________________________________

Physician’s signature: ____________________________ Date/Time_________________/________

Send to : Central Intake Fax: (604) 585-5968 Phone: (604) 585-5666 ext. 7474 Include: 1) Referral form signed by physician 2) Labs and diagnostic test results 3) Consultation Reports

Session Objectives

1.

Identify Regional Stroke Strategy priorities

2.

Review access for TIA Clinics3.

Show key findings from 2011National Stroke Audit

National Stroke Audit 2011

Random sample chart audit (08-09)

38,200 patients

295 Hospitals

“Time is Brain”• 2/3 of ischemic strokes do not arrive in time at an appropriate hospital to receive optimal care

• 30% of stroke patients did not arrive at the hospital by ambulance (BC 27%)

• 39% of all patients arrived at the hospital more than 12 hours after symptom onset (BC 35%)

• Median arrival time to hospital was 7 hrs after symptom onset – optimum treatment window is 4.5 hours

Stroke Units

Patients need greater access to stroke units:

Only 23% of stroke patients in Canada are treated in a specialized stroke unit while in hospital. This number is substantially lower than in other countries

Acute Stroke Care

Other areas of stroke care could be improved:

Of concern is the low level (50%) of documented dysphagia screening to assess swallowing difficulties

Rehab Access

Only 37% of moderate to severe stroke cases discharged to a rehabilitation facility

Stroke PreventionThe risk factors for stroke need to be better controlled:

64% of patients with stroke have hypertension, and more than one-third have experienced a previous stroke or transient ischemic attack (TIA)

Questions?