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Improving Access to Quality
Stroke Care in
Waterloo/Wellington
Tammy Tebbutt
May 11th, 2013
Why is this happening?
We want to make rehabilitation better for
patients across Waterloo and Wellington
•The stroke stream is part of a broader rehabilitation review
•There are three other aspects to this review, covering
– Musculo-skeletal care
– Care for the frail elderly
– Cardio-pulmonary care
•This involves hospitals and health providers from across
Waterloo and Wellington
Stroke is a system of care
We need to prevent strokes, treat them as
quickly as possible, provide timely access to
rehabilitation and help people as they go home.
What is/isn’t working now?
We have great providers who
do their very best for patients.
The stroke system in Waterloo
and Wellington has too many
pieces in too many places.
•There aren’t consistent ways of caring for people
•There isn’t a way to give patients access to the best specialists
all the time, no matter where they live.
•We can do better, and improve outcomes for patients.
What do we propose?
To develop a stroke system that has better
results for patients and families
•Access to specialized, timely stroke care for all stroke patients
in Waterloo and Wellington
•Concentrate stroke beds to make sure patients have the best
access to the care they need (critical mass)
•Develop designated stroke units with dedicated stroke staff
receiving the latest training to give patients the best results
•Partnerships with the Community Care Access Centre and
other community stakeholders to help patients when they
recover at home
Preventing strokes and acting faster
•We need families/friends to recognize the signs and
symptoms of stroke, recognize this is a medical
emergency and call 9-1-1 right away:
�Sudden weakness
�Trouble speaking
�Vision problems
�Headache
�Dizziness
•EMS can get patients to care faster, and ensure faster
access to clot-busting drugs (when appropriate)
Changing the care system for the better
• Care in an emergency will remain the same. People will
continue to go directly to Grand River Hospital in Kitchener for
assessment for clot-busting medications. We continue to
review whether other sites should be equipped to provide this
therapy.
• Inpatient acute and rehabilitation stroke unit care will be
consolidated to create critical mass
• We are finalizing and refining where the services will be
located
• Working with CCAC to develop a model of care for better
community care when patients return home
New Model of Stroke System of Care in
Waterloo/Wellington LHINRecommended by WW Rehab Council
waterloo_map.lnk
Acute Stroke Care• 2 Geographically Defined Stroke Units with dedicated staff
Inpatient Rehabilitation•3 Geographically Defined Stroke Rehab Units with dedicated staff
This is a big change. Why is this better?
Ontario Stroke Reference Panel has put forth province-wide recommendations for :
•Specialized Stroke Units
•Early admission to rehabilitation
•Intensity of therapy
•7 day a week admission – 7 day a week therapy
•Access for severe stroke
•Outpatient rehabilitation
Putting specialized resources in a few
large sites allows us to provide better
care.
Critical mass: bigger is better for patients
Stroke Expert Panel recent recommendations
(Feb 2013)
“to achieve the critical mass of expertise and
stroke unit admissions, each LHIN will need to
consider consolidation of stroke care in a few
number of hospitals in their region. Thus,
stroke-related bed days will be moved from
smaller centres to those with stroke units.”
Faster access to rehabilitation:
better outcomes for patients
Day 5 for ischemic stroke, Day 7 for hemorrhagic
Time is brain for acute stroke; but time is
function for rehab!
What changes we can make now?
• Applying a consistent “banding” approach… making sure we clearly identify stroke patients for their needs, so we can act on those needs faster
• Hiring a stroke navigator in May to assist with seamless, timely transitions
• Putting in place best practice clinical pathways to standardize care provided across the continuum of care
Stroke Navigator
• Anticipate the needs of stroke patients within
the system
• Ensure appropriate referral and placement of
stroke patients
• Ensure capacity and flow across the
continuum of the stroke system
• Develop transitional and discharge plans
• Ensure the right patient receives the right care
at the right time through management of wait
lists
Make acute care work better for patients
� Staff education surrounding best practices
• Patients automatically transition to rehab (no application)
• Expanding care plan to reflect best practice (e.g. oral care, continence assessment, etc)
• Improving access (move to 7 day a week care model for therapy, transfers and discharges)
– Currently a 5 day a week model
• Documentation – doing the right thing but remains a challenge to capture it and flow across and between sites
Making rehabilitation better for patients
New system changes include:
• Getting faster rehab access (inpt & outpt)
• Improve access for severe stroke patients getting to inpatient rehab
• Longer and more intensive therapy (move to 3 hrs/day 6-7 days a week)
– Currently patients receive an average of a little over 1 hour of therapy per day 5 days per week
• Specialized stroke rehabilitation units with dedicated teams (nursing, allied health, medical)
What will our communities gain?
A stroke patient’s time in hospital is short.
Their time at home is longer.•Ensure that patients are embraced and supported with an
appropriate community resource when they return to their
community
•Work with stream lead organizations to develop the
community services sector of the standardized care paths
•Develop trust and capacity in the system to ensure patients
get the right care, at the right time, in the right place
•Link with primary care to ensure that they have information
regarding the availability/processes to access community
services
Community Planning
Community Integration Teams
Features of WWCCAC Proposed Stroke
Rehabilitative Care Model1. Designated hospital and community care coordinators
to support client transition to home and/or community
programs; and work closely with Stroke Flow Navigator.
2. ‘Discharge Link’ meeting with most responsible
community clinician, hospital team, and hospital care
coordinator.
3. Most responsible community clinician to make first
treatment visit to client within 7 days of hospital
discharge. (Phase 1 and 48 hours Phase 2)
4. ONE community service provider for all disciplines to
facilitate development of skills in stroke treatment and
inter-disciplinary communication.
5. Improved linkage with primary care
What’s a care pathway?
Why does it matter?
Working Groups across the Continuum
Integrated care pathway
• It’s a way of knowing every step of a patient’s care when they have a stroke.
• We can then respond faster and better to their needs at a given point.
• Six groups across continuum are mapping out the patient journey
• They’re working with the identified clinical experts to develop a better system that will be more responsive to patients, whether they’re in an ambulance, in hospital or back at their homes
What is the timeline for change?
• March and April: consult with communities• April: hospitals/health providers to consider the
changes• June: decision by LHIN Board• Full implementation of changes to be completed in
2013 - 2014
Discussion
What’s important to you for stroke care?
What do you think about what you’ve seen?
Do you have questions/concerns that you would like followed-up on?
How do you want receive updates/information moving forward