regional stroke update april14 12
TRANSCRIPT
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3rd Annual Fraser Health Stroke SymposiumSheraton Guildford Hotel, Surrey Saturday, April 14, 2012
Regional Stroke Strategy
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Session Objectives
1.
Identify Regional Stroke Strategy priorities
2.
Review access for TIA Clinics3.
Show key findings from 2011National Stroke Audit
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Session Objectives
1.
Identify Regional Stroke Strategy priorities
2.
Review access for TIA Clinics3.
Show key findings from 2011National Stroke Audit
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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%
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Regional Priorities• Acute Stroke Service• Bypass protocols• Improve tPA rates• Stroke Cohort Units
SMH (2009)RCH (2010)BGH (2011)ARH (2012)
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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
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Surrey Critical Care Tower
• 36 Bed Neurology Unit
• Acute Stroke Unit
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Regional PrioritiesRehab services•REDI program – early supported discharge
Community Reintegration•STart program (Abbotsford) – transitions from acute to community
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Regional PrioritiesStroke Education Workshops (2012)• 500 medicine seats• 250 rehab seats• 130 emergency seats
Online Learning Module (Hemispheres)• 100 seats for developing stroke champions
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Session Objectives
1.
Identify Regional Stroke Strategy priorities
2.
Review access for TIA Clinics
3.
Show key findings from 2011National Stroke Audit
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Fraser North RCH
Fraser EastARHCC
Fraser SouthSMH
2000+Patients seen in
past 12 months
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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
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Session Objectives
1.
Identify Regional Stroke Strategy priorities
2.
Review access for TIA Clinics3.
Show key findings from 2011National Stroke Audit
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National Stroke Audit 2011
Random sample chart audit (08-09)
38,200 patients
295 Hospitals
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“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
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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
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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
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Rehab Access
Only 37% of moderate to severe stroke cases discharged to a rehabilitation facility
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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)