CRSN Acute Care

 

The Impact of Stroke

IN ONTARIO

IN CANADA

  • Third leading cause of death in Ontario; annually nearly 6,000 Ontarians die from stroke.
  • ~ 22,000 stroke/TIA visits to Ontario EDs2
  • ~ 15,300 inpatient admissions2
  • 67% Ischemic
  • 18% TIAs
  • 15% Hemmorrhagic
  • At least 90,000 are living with the effect of stroke and costs the Ontario economy almost $1billion annually3
  • In 2007/2008 56% of stroke/TIA patients were discharged home from hospital2
  • In 2007/2008 23% of stroke/TIA patients were discharged to rehabilitation from acute hospital2
  • In 2007/2008 7% of stroke/TIA patients were discharged to long term care after acute hospitalization2

1 Statistics Canada – Catalogue no. 84-215-X

2 Ontario Stroke Evaluation Report 2010: Technical Report. Toronto: ICES

3 Report of the Joint Stroke Strategy Working Group. 2000.Ministry of Health and Long-Term Care

  • Third leading cause of death in Canada; annually nearly 14,000 die from stroke1
  • 50,000 strokes in Canada each year. One stroke every 10 minutes.
  • For every 100,000 Canadian children under the age of 19, there are 6.7 strokes.
  • About 300,000 Canadians are living with the effects of stroke.
  • Stroke costs the Canadian economy $3.6 billion a year in physician services, hospital costs, lost wages, and decreased productivity.
  • Canadians spend a total of 3 million days in hospital because of stroke.

Source: Heart & Stroke Foundation of Ontario, Stroke Statistics [online]

 

What is Stroke?

Stroke is a syndrome caused by a sudden disruption in blood flow to a part of the brain. It occurs when the blood vessel either ruptures or becomes occluded. It deprives the neurons and other brain cells of glucose and oxygen leading to cell death.  If blood flow is not restored within minutes, this will result in damage to the brain tissue and ultimately a loss or impairment of function.

There are different types of stroke:

  • Ischemic (blockage in an artery): occurs as a result of an occlusion or blockage in blood flow in the artery. Represents approximately 80% of all strokes. Most commonly as a result of narrowing of the artery as a result of atherosclerosis which results in reduced blood flow to brain tissue. There are four (4) subtypes of ischemic stroke: thrombotic, embolic, cryptogenic and small vessel (lacunar).
  • Hemorrhagic (an artery rupture): occurs as a result of interrupted blood flow due to a rupture of the artery. There are two common types of hemorrhagic stroke: intracerebral and subarachnoid.
  • Transient Ischemic Attack (TIA): a transient episode of neurological dysfunction that resolves within 24 hours caused by an interruption in blood flow to the brain.

Regional Paramedic Program of Eastern Ontario (RPPEO) 

The Canadian Stroke Network estimates that more than half of patients suspected of having a stroke are transported by EMS. As such, paramedics play an important role in stroke care by identifying patients suspected of experiencing acute stroke symptoms and transporting them to an appropriate facility in a timely fashion. One of the roles of Regional Stroke Centres is to bring together all stakeholders in stroke care, including pre hospital sector, to build networks to develop a consistent approach to stroke care across regions. In areas of the province with a designated stroke centre, paramedics may be authorized in certain circumstances to bypass community hospitals under protocol in favour of a Designated Stroke Centre (Regional, District or Telestroke) where the patient would have access to specialized treatment.

The PARAMEDIC PROMPT CARD FOR ACUTE STROKE PROTOCOL was developed and distributed to paramedics across the province in 2004. This tool was designed to assist paramedics in determining the most appropriate hospital for patients experiencing signs and symptoms of acute stroke. The Paramedic Prompt Card provides paramedics with a quick reference of the indications and contraindications for bypassing a community hospital and transporting patients directly to a Designated Stroke Centre under an approved Acute Stroke Protocol.

In January 2014, The Champlain Emerergency Service Network (CESN) and the CRSN launched a WALK-IN Transfer Protocol of Acute Stroke TPA Candidates.  This protocol allows ED stroke patients who meet the Acute Stroke Protocol to be quickly transferred to their designated Stroke Centre.  A sample poster can be viewed here.

If you have any questions about the Walk- In Stroke Protocol or would like a copy of the site specific posters, please contact Whitney Kucey,  Acute Care Coordinator at the Champlain Regional Stroke Network This email address is being protected from spambots. You need JavaScript enabled to view it..

What is tPA?

tPA (tissue plasminogen activator) is a thrombolytic or a ‘Clot Buster’ drug. tPA is an intravenous drug that can stop a stroke caused by a blood clot by breaking up the clot and can only be given to patients who are having an ischemic stroke. The drug must be administered within 4.5 hours of symptom onset.The earlier it is given, the better – time is critical.

The decision to give tPA is made by the medical team after a number of tests have been completed, ensuring the stroke patient meets the criteria. tPA is able to reverse the effects of stroke and improve the chances of recovery. There are risks associated with tPA, including a risk of bleeding. The best chance of a full recovery from a stroke caused by a blocked artery is with the use of TPA. If you choose not to have tPA treatment your care will not be affected. You will receive the usual treatment for stroke. This will be explained to you by your physician.

If you have any questions about tPA or other treatment for stroke, please talk to your physician or any member of your health care team.

You may be interested to know that 1.9 million brain cells die for each minute a stroke patient waits for treatment with tPA. The quick delivery of tPA can contribute to saving billions of brain cells and hence, the significant improvement for the quality of life enjoyed by the patient.

Successful Initiatives

The Acute Stroke Care Recognition Program was launched at The Ottawa Hospital, by the CRSN, in 2010 that recognizes those members of the stroke code team (Paramedics, ED RNs, Clerks, Orderlies, DI, SW, Neurologists, Doctors and Residents) that help to achieve a door to needle time (from patient triage to time of tPA administration) of 35 minutes or under. The recognition program has helped reduce the door to needle time at The Ottawa Hospital to our target of 48 minutes, and has helped to maintain that time consistently for over 2 years. The CRSN Door-to-Needle Time Team was recognized at the  The Ottawa Hospital's 5th Annual Quality Awards for their achievement in reducing overall time to tPA administration in acute stroke patients. We also have a Quality Pin awarded to those individuals that go above and beyond with their care for stroke patients.

Telestroke

The Ontario Telestroke Program was launched in 2002 to increase access to tPA for stroke patients living in remote areas. Telestroke centres are hospitals equipped to use live, two-way television and digital image transfer to connect emergency physicians in smaller institutions with stroke neurologists located at larger urban health care facilities. Telestroke allows for the assessment and treatment of patients experiencing acute stroke symptoms, via consult with a remote neurologist/stroke specialist. This technology makes it possible for more patients to receive highly effective stroke treatment in areas of the province where travel to a stroke centre is not feasible. Telestroke has helped to improve access of treatment with tpa to those in rural and remote areas of Ontario.

Acute Stroke Unit Care

A stroke unit is a specialized, geographically defined hospital unit dedicated to the management of stroke patients and staffed by an interprofessional team. 100% of stroke patients can benefit from stroke unit care (reduce morbidity, mortality and length of stay, and increase number of patients going home, while improving the quality of life for stroke patients).

Clinical evidence suggests that clustering stroke patients on a single care unit:

Stroke Code Roadmap - Example from TOH Civic Campus .pdf

Current Stroke Units/Cohorts:

Memo - Acute Stroke Unit/Cohort Sites

Canadian Best Practice Recommendations for Stroke Care

The Canadian Best Practice Recommendations for Stroke Care are a joint initiative of the Canadian Stroke Network and The Heart and Stroke Foundation of Canada.  The guidelines compile the latest high-quality and evidence-based research in stroke care into recommendations that healthcare professionals can use to improve the care provided to stroke patients for Hyper Acute Stroke Management and Acute Stroke Management.

Champlain Regional Stroke Prevention and Acute Care Committee (CRSPACC)

This sub-committee has the mandate to advise the CRSN Steering Committee regarding the development, implementation, and evaluation of regional stroke prevention and acute care best practice initiatives and system activities throughout the Champlain region. CRSPACC Membership on this sub-committee represents the balance and skills the sub-committee needs to act as advisor to the aforementioned committees; the sub-committee membership also represents the diversity of the CRSN, including diversity in the region’s geography and its communities. The 2016-18 CRSPACC Workplan was approved by the sub-committee at our quarterly meeting in March 2016.

Interim Chair: Donna Cousineau

CRSN Support: Whitney Kucey

CRSN Support: Aline Bourgoin

APN Chronic Disease Prevention & Management

Regional Stroke Acute Care Coordinator

Regional Stroke Prevention Care Coordinator

Queensway Carleton Hospital

Champlain Regional Stroke Network

Champlain Regional Stroke Network

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Questions or Comments? Contact:
Whitney Kucey, B.H.K., M.H.A.
Acute Care Coordinator
Coordonnatrice des soins de courte durée
Champlain Regional Stroke Network
Réseau Régional des AVC Champlain
The Ottawa Hospital – Civic Campus
Parkdale Clinic, Room 35
1053 Carling Avenue, Ottawa, ON K1Y 4E9
613-798-5555 ext. 16176
613-371-5603
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Contact us

Champlain Regional Stroke Network The Ottawa Hospital - Civic Campus Civic Parkdale Clinic, Main North 1053 Carling Avenue Ottawa, ON K1Y 4E9

Phone: 613-798-5555 x 16153
SPC Phone: 613-798-5555 x 16156