1. Regional
Stroke Strategy
3rd Annual Fraser Health Stroke Symposium
Sheraton Guildford Hotel, Surrey
Saturday, April 14, 2012

2. Session Objectives
1.
2.
3.
Identify Regional Stroke Strategy
priorities
Review access for TIA Clinics
Show key findings from
2011National Stroke Audit

3. Session Objectives
1.
Identify Regional Stroke
Strategy priorities
2.
Review access for TIA Clinics
Show key findings from
2011National Stroke Audit
3.

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

6. Regional Priorities
• Acute Stroke Service
• Bypass protocols
• Improve tPA rates
• Stroke Cohort Units
SMH (2009)
RCH (2010)
BGH (2011)
ARH (2012)

7. 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

8. Surrey Critical Care Tower
• 36 Bed
Neurology
Unit
• Acute
Stroke Unit

9. Regional Priorities
Rehab services
•REDI program – early supported discharge
Community Reintegration
•STart program (Abbotsford) – transitions
from acute to community

10. 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

11. Session Objectives
1.
Identify Regional Stroke Strategy
priorities
2.
Review access for TIA
Clinics
3.
Show key findings from 2011National
Stroke Audit

12. Fraser North
RCH
2000+
Patients seen in
past 12 months
Fraser South
SMH
Fraser East
ARHCC

13. 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_________________/________

14. Session Objectives
1.
2.
3.
Identify Regional Stroke Strategy
priorities
Review access for TIA Clinics
Show key findings from
2011National Stroke Audit

15. National Stroke Audit 2011
Random sample
chart audit (08-09)
38,200 patients
295 Hospitals

16. “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

17. 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

18. 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

19. Rehab Access
Only 37% of moderate to severe
stroke cases discharged to a
rehabilitation facility

20. 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)

21. Questions?