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 E...
together…Working for healthy people in healthy communities.OutlineImprovement Story:• 2012 Evaluation Results: Data………• Le...
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 StrokeRehabIntegr...
Working together…for healthy people in healthy communities.GOAL: To organize ( improve and integrate)stroke care in the Su...
Working together…for healthy people in healthy communities.Evaluation• Data collection over 2 years- 2009-2011• Document a...
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, R...
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 T...
Working together…for healthy people in healthy communities.Acute Care• 50% returned to own home• 20% outpatient therapy an...
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•...
Working together…for healthy people in healthy communities.Stroke Rehab Program• 37 stroke survivorsadmitted• 81% diagnosi...
Working together…for healthy people in healthy communities.Stroke Rehab Program• 1/3 from Yorkton, 2/3 “rural”• 2/3 from Y...
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 2...
• 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 Ther...
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 cl...
• 175 people withstroke symptomsreceived 215 visits• 35% from Yorkton• 65% RuralWorking together…for healthy people in hea...
Referrals• 50% Primarycare/physicians• 20% Acute Care• 17% ER• 13% RQHRneurologists or SPCclinicWorking together…for healt...
• Median time ABDC² > 4 to clinic - 11 days (75%21 days)• 186 client visits :– 49% CT scans– 40% Carotid Dopplers– 31% Hol...
“It was one on one, the same as being inthe office with him…he explainedeverything very well…to me it was if I wastalking ...
Working together…for healthy people in healthy communities.• 112 family members participated• Mean age 73 years (17-96)• 6...
Working together…for healthy people in healthy communities.Stroke Prevention Clinic• 3 clients with symptomatic stenosisre...
Working together…for healthy people in healthy communities.Risk FactorsOf 175 clients:• 60% Hypertension• 39% Dyslipidemia...
Working together…for healthy people in healthy communities.“Improved andintegrated strokecare will changethe lives ofSaska...
Working together…for healthy people in healthy communities.“I was very impressed with thistechnology, it was easy for me a...
Working together…for healthy people in healthy communities.“The clinic saved me a trip and time andmoney to go to Regina a...
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 Ph...
Working together…for healthy people in healthy communities.Stroke Prevention Clinic• Telehealth -larger screen/speakers• A...
Working together…for healthy people in healthy communities.
Working together…for healthy people in healthy communities.Strengths/Highlights• Stroke Services Manager• RQHR SPC Team• E...
``The more the complex the health needs and the moreinterdependency needed to serve the patient, the greaterthe need for t...
Working together…for healthy people in healthy communities.What We Learned-Key Points• Tertiary/Regional Partnerships• Neu...
Working together…for healthy people in healthy communities.Where Next?
Working together…for healthy people in healthy communities.
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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.

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

Published in: Health & Medicine
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Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region

  1. 1. Saskatchewan Integrated Stroke StrategyJacquie Holzmann, Shannon SchmidtThis Session is sponsored by:
  2. 2. 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
  3. 3. together…Working for healthy people in healthy communities.OutlineImprovement Story:• 2012 Evaluation Results: Data………• Lessons Learned• Continuous Improvement
  4. 4. together…Working for healthy people in healthy communities.
  5. 5. Working together…for healthy people in healthy communities.
  6. 6. Working together…for healthy people in healthy communities.Saskatchewan IntegratedStroke Strategy-Pilot
  7. 7. Working together…for healthy people in healthy communities.5 key elementsStrokePreventionClinicInpatient StrokeRehabIntegratedStroke StrategySteeringCommitteeStroke ServicesManagerTelehealth andDiagnosticTechnology
  8. 8. 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)”
  9. 9. 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
  10. 10. Working together…for healthy people in healthy communities.Pre-Hospital and EmergencyCare
  11. 11. 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
  12. 12. Working together…for healthy people in healthy communities.Acute Care
  13. 13. 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)
  14. 14. 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
  15. 15. Working together…for healthy people in healthy communities.
  16. 16. Working together…for healthy people in healthy communities.Stroke Rehabilitation
  17. 17. 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
  18. 18. 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)
  19. 19. 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
  20. 20. Working together…for healthy people in healthy communities.50% had FIM score of 20+ and clinically meaningful gains
  21. 21. Working together…for healthy people in healthy communities.• 2009-56% had + change in FIM admission to discharge• 83% in 2011• Over 2 years 67%
  22. 22. • 55% returned home,• 17% to LTC• 11% ALC• 15% returned toAcute Care• CSN- 60 % returnhome, 10 % returnedto LTC
  23. 23. Working together…for healthy people in healthy communities.Interdisciplinary Team• Physical Therapy100%• Occupational Therapy100%• Speech LanguagePathology 65%• Social Worker 89%*
  24. 24. Working together…for healthy people in healthy communities.Stroke Prevention Clinic
  25. 25. Working together…for healthy people in healthy communities.
  26. 26. 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”
  27. 27. • 175 people withstroke symptomsreceived 215 visits• 35% from Yorkton• 65% RuralWorking together…for healthy people in healthy communities.
  28. 28. Referrals• 50% Primarycare/physicians• 20% Acute Care• 17% ER• 13% RQHRneurologists or SPCclinicWorking together…for healthy people in healthy communities.
  29. 29. • 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.
  30. 30. “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”
  31. 31. 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.
  32. 32. 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
  33. 33. 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
  34. 34. Working together…for healthy people in healthy communities.“Improved andintegrated strokecare will changethe lives ofSaskatchewanpeople who are atrisk or haveexperienced astroke.”
  35. 35. 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.”
  36. 36. 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 …”
  37. 37. Working together…for healthy people in healthy communities.Challenges/Obstacles
  38. 38. 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
  39. 39. 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
  40. 40. Working together…for healthy people in healthy communities.
  41. 41. 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
  42. 42. ``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.
  43. 43. 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
  44. 44. Working together…for healthy people in healthy communities.Where Next?
  45. 45. Working together…for healthy people in healthy communities.
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