Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region
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Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region

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Improvement Story session at the 2013 Saskatchewan Health Care Quality Summit. For more information about the summit, visit www.qualitysummit.ca. Follow @QualitySummit on Twitter. ...

Improvement Story session at the 2013 Saskatchewan Health Care Quality Summit. For more information about the summit, visit www.qualitysummit.ca. Follow @QualitySummit on Twitter.

Better Care for clients and families experiencing or at risk for stroke or transient ischemic attacks (TIA's) using telehealth and multidisciplinary and inter-regional resources was realized in Sunrise Health Region over the course of a two year pilot.
Better Care

Jacquie Holzmann, Sunrise Health Region, Shannon Schmidt, Sunrise Health Region

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Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region Presentation Transcript

  • Saskatchewan Integrated Stroke StrategyJacquie Holzmann, Shannon SchmidtThis Session is sponsored by:
  • Working together…for healthy people in healthy communities.Improvement Story:Saskatchewan Integrated StrokeStrategy:2012 EvaluationSunrise Health RegionPresenters:Jacquie Holzmann, Director of TherapiesShannon Schmidt, Manager Integrated Therapies/StrokeServicesThursday, April 11th, 11:00 AM
  • together…Working for healthy people in healthy communities.OutlineImprovement Story:• 2012 Evaluation Results: Data………• Lessons Learned• Continuous Improvement
  • together…Working for healthy people in healthy communities.
  • Working together…for healthy people in healthy communities.
  • Working together…for healthy people in healthy communities.Saskatchewan IntegratedStroke Strategy-Pilot
  • Working together…for healthy people in healthy communities.5 key elementsStrokePreventionClinicInpatient StrokeRehabIntegratedStroke StrategySteeringCommitteeStroke ServicesManagerTelehealth andDiagnosticTechnology
  • Working together…for healthy people in healthy communities.GOAL: To organize ( improve and integrate)stroke care in the Sunrise Health Region.“the right services ( best practise) in theright place (close to where families liveand work; accessible) at the right time(saves lives, improves outcomes)”
  • Working together…for healthy people in healthy communities.Evaluation• Data collection over 2 years- 2009-2011• Document analysis• Program indicator reports• Client feedback• Health care provider interviews• Focus Groups
  • Working together…for healthy people in healthy communities.Pre-Hospital and EmergencyCare
  • Working together…for healthy people in healthy communities.Stroke Care• Over 26 months- 285 people in SHRreceived acute, Rehab and/or strokeprevention care• 70% from “rural”• 30% TIA• 36% stroke/CVAs• 5% transferred to RQHR for care• 4% received rtPA
  • Working together…for healthy people in healthy communities.Acute Care
  • Working together…for healthy people in healthy communities.Acute Care• Non-cohort, acute care beds admitted onaverage 45 TIA/Strokes/year• Mean age 72 (19-93)• Average LOS 10 days (1-121) (16 days -Canadian Stroke Network, CSN 2011)
  • Working together…for healthy people in healthy communities.Acute Care• 50% returned to own home• 20% outpatient therapy and/or communitysupport• 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
  • Working together…for healthy people in healthy communities.
  • Working together…for healthy people in healthy communities.Stroke Rehabilitation
  • Working together…for healthy people in healthy communities.Interdisciplinary Team• Physical Therapy• Occupational Therapy• Therapy Assistant• Speech Language Pathologist• Social Worker• Clinic Care Coordinator-RN• Special Care Aide
  • Working together…for healthy people in healthy communities.Stroke Rehab Program• 37 stroke survivorsadmitted• 81% diagnosis ofischemic stroke• 14% Hemorrhagicstroke• 11% had received rtPA• Mean Age 72.2 (41- 96)
  • Working together…for healthy people in healthy communities.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
  • Working together…for healthy people in healthy communities.50% had FIM score of 20+ and clinically meaningful gains
  • Working together…for healthy people in healthy communities.• 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 toAcute Care• CSN- 60 % returnhome, 10 % returnedto LTC
  • Working together…for healthy people in healthy communities.Interdisciplinary Team• Physical Therapy100%• Occupational Therapy100%• Speech LanguagePathology 65%• Social Worker 89%*
  • Working together…for healthy people in healthy communities.Stroke Prevention Clinic
  • Working together…for healthy people in healthy communities.
  • Working together…for healthy people in healthy communities.“It is not just the day we see patients viatelehealth in the clinic-there is a lot of beforeand after testing, referral, follow-ups andtracking and double checking that needs tobe done”
  • • 175 people withstroke symptomsreceived 215 visits• 35% from Yorkton• 65% RuralWorking together…for healthy people in healthy communities.
  • Referrals• 50% Primarycare/physicians• 20% Acute Care• 17% ER• 13% RQHRneurologists or SPCclinicWorking together…for healthy people in healthy communities.
  • • 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 referralsWorking together…for healthy people in healthy communities.
  • “It was one on one, the same as being inthe office with him…he explainedeverything very well…to me it was if I wastalking with the doctor in person”
  • Working together…for healthy people in healthy communities.• 112 family members participated• Mean age 73 years (17-96)• 66% of visits were 70-89 years.
  • Working together…for healthy people in healthy communities.Stroke Prevention Clinic• 3 clients with symptomatic stenosisreferred for endartectomy• 49% seen in SPC had documenteddiagnosis not related to stroke
  • Working together…for healthy people in healthy communities.Risk FactorsOf 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
  • Working together…for healthy people in healthy communities.“Improved andintegrated strokecare will changethe lives ofSaskatchewanpeople who are atrisk or haveexperienced astroke.”
  • Working together…for healthy people in healthy communities.“I was very impressed with thistechnology, it was easy for me and I thinkcost effective for our health region.”“It think it is a great way to access aneurologist without long trips to Reginaand long wait times.”
  • Working together…for healthy people in healthy communities.“The clinic saved me a trip and time andmoney to go to Regina and I got thesame results.”“Saved us so many trips to have all thetests done in one day, my husband wasnot well …”
  • Working together…for healthy people in healthy communities.Challenges/Obstacles
  • Working together…for healthy people in healthy communities.Rehabilitation• Medical stability prior to transfer• On site Physician support• Increased Nursing/Rehab workload in acutecare and LTC• Evening/weekend-programming
  • Working together…for healthy people in healthy communities.Stroke Prevention Clinic• Telehealth -larger screen/speakers• Access-test results-EMR• Recruitment (medical cardiac sonographer)• Carotid Dopplers/Echocardiograms• NP Model vs. Nurse
  • Working together…for healthy people in healthy communities.
  • Working together…for healthy people in healthy communities.Strengths/Highlights• Stroke Services Manager• RQHR SPC Team• ELT support and culture of change• Rehab facility that fosters functionalrehabilitation• Health Foundation support
  • ``The more the complex the health needs and the moreinterdependency needed to serve the patient, the greaterthe need for team collaboration`` (CHSFR 2006)Working together…for healthy people in healthy communities.
  • Working together…for healthy people in healthy communities.What We Learned-Key Points• Tertiary/Regional Partnerships• Neurologists Partnership• Staff training/education• Telehealth• Client and family centred stroke care
  • Working together…for healthy people in healthy communities.Where Next?
  • Working together…for healthy people in healthy communities.