Regional stroke update april14 12

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Regional stroke update april14 12

  1. 1. Regional Stroke Strategy 3rd Annual Fraser Health Stroke Symposium Sheraton Guildford Hotel, Surrey Saturday, April 14, 2012
  2. 2. Session Objectives 1. 2. 3. Identify Regional Stroke Strategy priorities Review access for TIA Clinics Show key findings from 2011National Stroke Audit
  3. 3. Session Objectives 1. Identify Regional Stroke Strategy priorities 2. Review access for TIA Clinics Show key findings from 2011National Stroke Audit 3.
  4. 4. 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
  5. 5. Regional Priorities • Acute Stroke Service • Bypass protocols • Improve tPA rates • Stroke Cohort Units SMH (2009) RCH (2010) BGH (2011) ARH (2012)
  6. 6. 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
  7. 7. Surrey Critical Care Tower • 36 Bed Neurology Unit • Acute Stroke Unit
  8. 8. Regional Priorities Rehab services •REDI program – early supported discharge Community Reintegration •STart program (Abbotsford) – transitions from acute to community
  9. 9. 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
  10. 10. Session Objectives 1. Identify Regional Stroke Strategy priorities 2. Review access for TIA Clinics 3. Show key findings from 2011National Stroke Audit
  11. 11. Fraser North RCH 2000+ Patients seen in past 12 months Fraser South SMH Fraser East ARHCC
  12. 12. 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_________________/________
  13. 13. Session Objectives 1. 2. 3. Identify Regional Stroke Strategy priorities Review access for TIA Clinics Show key findings from 2011National Stroke Audit
  14. 14. National Stroke Audit 2011 Random sample chart audit (08-09) 38,200 patients 295 Hospitals
  15. 15. “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
  16. 16. 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
  17. 17. 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
  18. 18. Rehab Access Only 37% of moderate to severe stroke cases discharged to a rehabilitation facility
  19. 19. 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)
  20. 20. Questions?

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