saskatchewan integrated stroke strategy: 2012 evaluation sunrise health region

Saskatchewan Integrated Stroke Strategy Jacquie Holzmann, Shannon Schmidt

This Session is sponsored by:

Working together…for healthy people in healthy communities.

Improvement Story:

Saskatchewan Integrated Stroke

Strategy:

2012 Evaluation

Sunrise Health Region

Presenters:

Jacquie Holzmann, Director of Therapies

Shannon Schmidt, Manager Integrated Therapies/Stroke

Services

Thursday, April 11th, 11:00 AM

together…Working for healthy people in healthy communities.

Outline

Improvement Story:

• 2012 Evaluation Results: Data………

• Lessons Learned

• Continuous Improvement

together…Working for healthy people in healthy communities.


Saskatchewan Integrated

Stroke Strategy-Pilot


5 key elements

Stroke Prevention

Clinic

Inpatient Stroke Rehab

Integrated Stroke Strategy

Steering Committee

Stroke Services Manager

Telehealth and Diagnostic Technology


GOAL: To organize ( improve and integrate)

stroke care in the Sunrise Health Region.

“the right services ( best practise) in the

right place (close to where families live

and work; accessible) at the right time

(saves lives, improves outcomes)”


Evaluation

• Data collection over 2 years- 2009-2011

• Document analysis

• Program indicator reports

• Client feedback

• Health care provider interviews

• Focus Groups


Pre-Hospital and Emergency

Care


Stroke Care • Over 26 months- 285 people in SHR

received acute, Rehab and/or stroke

prevention care

• 70% from “rural”

• 30% TIA

• 36% stroke/CVAs

• 5% transferred to RQHR for care

• 4% received rtPA


Acute Care


Acute Care

• Non-cohort, acute care beds admitted on

average 45 TIA/Strokes/year

• Mean age 72 (19-93)

• Average LOS 10 days (1-121) (16 days -

Canadian Stroke Network, CSN 2011)


Acute Care • 50% returned to own home

• 20% outpatient therapy and/or community

support

• 22% returned to acute care

• 10% to LTC

• 2/3 started therapy in acute care

• 10% Living with Stoke/TIA Education

• 9% did not survive stroke


Stroke Rehabilitation


Interdisciplinary Team

• Physical Therapy

• Occupational Therapy

• Therapy Assistant

• Speech Language Pathologist

• Social Worker

• Clinic Care Coordinator-RN

• Special Care Aide


Stroke Rehab Program

• 37 stroke survivors

admitted

• 81% diagnosis of

ischemic stroke

• 14% Hemorrhagic

stroke

• 11% had received rtPA

• Mean Age 72.2 (41- 96)


Stroke Rehab Program • 1/3 from Yorkton, 2/3 “rural”

• 2/3 from YRHC Acute Care

• Median time “medically stable” to admission-14.5 days

• 50% admitted within 14.5 days

• 75% admitted within 28 days

• ALOS 49 days (6-154)

• CSN- ALOS 35-42 days


50% had FIM score of 20+ and clinically meaningful gains


• 2009-56% had + change in FIM admission to discharge

• 83% in 2011

• Over 2 years 67%

• 55% returned home,

• 17% to LTC

• 11% ALC

• 15% returned to

Acute Care

• CSN- 60 % return

home, 10 % returned

to LTC


Interdisciplinary Team

• Physical Therapy

100%

• Occupational Therapy

100%

• Speech Language

Pathology 65%

• Social Worker 89%*


Stroke Prevention Clinic


“It is not just the day we see patients via

telehealth in the clinic-there is a lot of before

and after testing, referral, follow-ups and

tracking and double checking that needs to

be done”

• 175 people with

stroke symptoms

received 215 visits

• 35% from Yorkton

• 65% Rural


Referrals

• 50% Primary

care/physicians

• 20% Acute Care

• 17% ER

• 13% RQHR

neurologists or SPC

clinic


• Median time ABDC² > 4 to clinic - 11 days (75%

21 days)

• 186 client visits :

– 49% CT scans

– 40% Carotid Dopplers

– 31% Holter monitors

– 24% Echocardiograms

– 7% EEG*

– 5% EMG*

• 19% specialist referrals


“It was one on one, the same as being in

the office with him…he explained

everything very well…to me it was if I was

talking with the doctor in person”


• 112 family members participated

• Mean age 73 years (17-96)

• 66% of visits were 70-89 years.



• 3 clients with symptomatic stenosis

referred for endartectomy

• 49% seen in SPC had documented

diagnosis not related to stroke


Risk Factors

Of 175 clients:

• 60% Hypertension

• 39% Dyslipidemia

• 19% Coronary artery disease

• 17% Atrial fibrillation

• 16% Diabetes

• CSN- 64% Hypertension, almost ~25% Diabetes ,25%

Coronary artery disease, 16% Atrial fibrillation


“Improved and

integrated stroke

care will change

the lives of

Saskatchewan

people who are at

risk or have

experienced a

stroke.”


“I was very impressed with this

technology, it was easy for me and I think

cost effective for our health region.”

“It think it is a great way to access a

neurologist without long trips to Regina

and long wait times.”


“The clinic saved me a trip and time and

money to go to Regina and I got the

same results.”

“Saved us so many trips to have all the

tests done in one day, my husband was

not well …”


Challenges/Obstacles


Rehabilitation

• Medical stability prior to transfer

• On site Physician support

• Increased Nursing/Rehab workload in acute

care and LTC

• Evening/weekend-programming



• Telehealth -larger screen/speakers

• Access-test results-EMR

• Recruitment (medical cardiac sonographer)

• Carotid Doppler's/Echocardiograms

• NP Model vs. Nurse


Strengths/Highlights

• Stroke Services Manager

• RQHR SPC Team

• ELT support and culture of change

• Rehab facility that fosters functional

rehabilitation

• Health Foundation support

``The more the complex the health needs and the more

interdependency needed to serve the patient, the greater

the need for team collaboration`` (CHSFR 2006)



What We Learned-Key Points

• Tertiary/Regional Partnerships

• Neurologists Partnership

• Staff training/education

• Telehealth

• Client and family centred stroke care


Where Next?

saskatchewan integrated stroke strategy: 2012 evaluation sunrise health region

Health & Medicine