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Regional stroke update april14 12
 

Regional stroke update april14 12

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    Regional stroke update april14 12 Regional stroke update april14 12 Presentation Transcript

    • Regional Stroke Strategy 3rd Annual Fraser Health Stroke Symposium Sheraton Guildford Hotel, Surrey Saturday, April 14, 2012
    • Session Objectives 1. 2. 3. Identify Regional Stroke Strategy priorities Review access for TIA Clinics Show key findings from 2011National Stroke Audit
    • Session Objectives 1. Identify Regional Stroke Strategy priorities 2. Review access for TIA Clinics Show key findings from 2011National Stroke Audit 3.
    • 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 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% TIA
    • Regional Priorities • Acute Stroke Service • Bypass protocols • Improve tPA rates • Stroke Cohort Units SMH (2009) RCH (2010) BGH (2011) ARH (2012)
    • Stroke Cohorts • Co-locating stroke patients • Nursing education enhanced • Care path and order sets updated • Electronic referral system • Reduce complications: Skin breakdown Dysphagia related pneumonia Incontinence VTE
    • Surrey Critical Care Tower • 36 Bed Neurology Unit • Acute Stroke Unit
    • Regional Priorities Rehab services •REDI program – early supported discharge Community Reintegration •STart program (Abbotsford) – transitions from acute to community
    • Regional Priorities Stroke 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 2000+ Patients seen in past 12 months Fraser South SMH Fraser East ARHCC
    • Referral Process STROKE PREVENTION CLINIC FHA Physician Referral • Faxed referral form Brief history Date/time onset ABCD2 score • Labs and diagnostics • Consult reports • Patient called directly Send to : Central Intake Fax: (604) 585-5968 Patient Name: D.O.B.: PHN: Phone (Home): Phone (Cell): Address: Phone: (604) 585-5666 ext. 7474 Include: 1) Referral form signed by physician 2) Labs and diagnostic test results 3) Consultation Reports □ Surrey Memorial Hospital □ Royal Columbian Hospital □ ARHCC □ Any Site Clinic Location Requested: Note: Coloured lines and text do not Referring Physician: _____________________________ Phone #: _______________________ appear on final form. Physician Billing #: _________________________ PHYSICIAN: PLEASE COMPLETE ALL SECTIONS 1. □ First Episode CLINICAL FEATURES: Date/Time of onset : Reason for Referral: □ Recurrent Episodes ________________________ / _____________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 2. RISK STRATIFICATION for EARLY STROKE ABCD² Scoring POINTS ≥ 60 years old Age Blood Pressure Clinical Features 1 1 2 1 0 2 1 0 1 Systolic ≥140 mm Hg and/or Diastolic ≥ 90 mm Hg Unilateral weakness Speech disturbance without weakness Other ≥ 60 minutes Duration of Symptoms 10-59 minutes < 10 minutes Diabetes Diabetes Mellitus TOTAL SCORE Score 2-Day Risk of Stroke 0 - 3 4 - 5 6 - 7 1% 4.1% 8.1% 3. INVESTIGATIONS ORDERED: Risk Low Risk Higher Risk Consider Admission Target Referral Time 48 to 72 hours 24 to 48 hours Immediate □ 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_________________/________
    • Session Objectives 1. 2. 3. Identify Regional Stroke Strategy priorities Review access for TIA Clinics 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 Prevention The 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?