![Page 1: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/1.jpg)
Saskatchewan Integrated Stroke Strategy Jacquie Holzmann, Shannon Schmidt
This Session is sponsored by:
![Page 2: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/2.jpg)
Working together…for healthy people in healthy communities.
Improvement Story:
Saskatchewan Integrated Stroke
Strategy:
2012 Evaluation
Sunrise Health Region
Presenters:
Jacquie Holzmann, Director of Therapies
Shannon Schmidt, Manager Integrated Therapies/Stroke
Services
Thursday, April 11th, 11:00 AM
![Page 3: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/3.jpg)
together…Working for healthy people in healthy communities.
Outline
Improvement Story:
• 2012 Evaluation Results: Data………
• Lessons Learned
• Continuous Improvement
![Page 4: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/4.jpg)
together…Working for healthy people in healthy communities.
![Page 5: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/5.jpg)
Working together…for healthy people in healthy communities.
![Page 6: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/6.jpg)
Working together…for healthy people in healthy communities.
Saskatchewan Integrated
Stroke Strategy-Pilot
![Page 7: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/7.jpg)
Working together…for healthy people in healthy communities.
5 key elements
Stroke Prevention
Clinic
Inpatient Stroke Rehab
Integrated Stroke Strategy
Steering Committee
Stroke Services Manager
Telehealth and Diagnostic Technology
![Page 8: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/8.jpg)
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 the
right place (close to where families live
and work; accessible) at the right time
(saves lives, improves outcomes)”
![Page 9: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/9.jpg)
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
![Page 10: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/10.jpg)
Working together…for healthy people in healthy communities.
Pre-Hospital and Emergency
Care
![Page 11: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/11.jpg)
Working together…for healthy people in healthy communities.
Stroke Care • Over 26 months- 285 people in SHR
received acute, Rehab and/or stroke
prevention care
• 70% from “rural”
• 30% TIA
• 36% stroke/CVAs
• 5% transferred to RQHR for care
• 4% received rtPA
![Page 12: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/12.jpg)
Working together…for healthy people in healthy communities.
Acute Care
![Page 13: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/13.jpg)
Working together…for healthy people in healthy communities.
Acute Care
• Non-cohort, acute care beds admitted on
average 45 TIA/Strokes/year
• Mean age 72 (19-93)
• Average LOS 10 days (1-121) (16 days -
Canadian Stroke Network, CSN 2011)
![Page 14: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/14.jpg)
Working together…for healthy people in healthy communities.
Acute Care • 50% returned to own home
• 20% outpatient therapy and/or community
support
• 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
![Page 15: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/15.jpg)
Working together…for healthy people in healthy communities.
![Page 16: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/16.jpg)
Working together…for healthy people in healthy communities.
Stroke Rehabilitation
![Page 17: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/17.jpg)
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
![Page 18: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/18.jpg)
Working together…for healthy people in healthy communities.
Stroke Rehab Program
• 37 stroke survivors
admitted
• 81% diagnosis of
ischemic stroke
• 14% Hemorrhagic
stroke
• 11% had received rtPA
• Mean Age 72.2 (41- 96)
![Page 19: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/19.jpg)
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
![Page 20: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/20.jpg)
Working together…for healthy people in healthy communities.
50% had FIM score of 20+ and clinically meaningful gains
![Page 21: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/21.jpg)
Working together…for healthy people in healthy communities.
• 2009-56% had + change in FIM admission to discharge
• 83% in 2011
• Over 2 years 67%
![Page 22: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/22.jpg)
• 55% returned home,
• 17% to LTC
• 11% ALC
• 15% returned to
Acute Care
• CSN- 60 % return
home, 10 % returned
to LTC
![Page 23: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/23.jpg)
Working together…for healthy people in healthy communities.
Interdisciplinary Team
• Physical Therapy
100%
• Occupational Therapy
100%
• Speech Language
Pathology 65%
• Social Worker 89%*
![Page 24: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/24.jpg)
Working together…for healthy people in healthy communities.
Stroke Prevention Clinic
![Page 25: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/25.jpg)
Working together…for healthy people in healthy communities.
![Page 26: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/26.jpg)
Working together…for healthy people in healthy communities.
“It is not just the day we see patients via
telehealth in the clinic-there is a lot of before
and after testing, referral, follow-ups and
tracking and double checking that needs to
be done”
![Page 27: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/27.jpg)
• 175 people with
stroke symptoms
received 215 visits
• 35% from Yorkton
• 65% Rural
Working together…for healthy people in healthy communities.
![Page 28: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/28.jpg)
Referrals
• 50% Primary
care/physicians
• 20% Acute Care
• 17% ER
• 13% RQHR
neurologists or SPC
clinic
Working together…for healthy people in healthy communities.
![Page 29: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/29.jpg)
• 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 referrals
Working together…for healthy people in healthy communities.
![Page 30: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/30.jpg)
“It was one on one, the same as being in
the office with him…he explained
everything very well…to me it was if I was
talking with the doctor in person”
![Page 31: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/31.jpg)
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.
![Page 32: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/32.jpg)
Working together…for healthy people in healthy communities.
Stroke Prevention Clinic
• 3 clients with symptomatic stenosis
referred for endartectomy
• 49% seen in SPC had documented
diagnosis not related to stroke
![Page 33: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/33.jpg)
Working together…for healthy people in healthy communities.
Risk Factors
Of 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
![Page 34: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/34.jpg)
Working together…for healthy people in healthy communities.
“Improved and
integrated stroke
care will change
the lives of
Saskatchewan
people who are at
risk or have
experienced a
stroke.”
![Page 35: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/35.jpg)
Working together…for healthy people in healthy communities.
“I was very impressed with this
technology, it was easy for me and I think
cost effective for our health region.”
“It think it is a great way to access a
neurologist without long trips to Regina
and long wait times.”
![Page 36: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/36.jpg)
Working together…for healthy people in healthy communities.
“The clinic saved me a trip and time and
money to go to Regina and I got the
same results.”
“Saved us so many trips to have all the
tests done in one day, my husband was
not well …”
![Page 37: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/37.jpg)
Working together…for healthy people in healthy communities.
Challenges/Obstacles
![Page 38: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/38.jpg)
Working together…for healthy people in healthy communities.
Rehabilitation
• Medical stability prior to transfer
• On site Physician support
• Increased Nursing/Rehab workload in acute
care and LTC
• Evening/weekend-programming
![Page 39: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/39.jpg)
Working together…for healthy people in healthy communities.
Stroke Prevention Clinic
• Telehealth -larger screen/speakers
• Access-test results-EMR
• Recruitment (medical cardiac sonographer)
• Carotid Doppler's/Echocardiograms
• NP Model vs. Nurse
![Page 40: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/40.jpg)
Working together…for healthy people in healthy communities.
![Page 41: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/41.jpg)
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 functional
rehabilitation
• Health Foundation support
![Page 42: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/42.jpg)
``The more the complex the health needs and the more
interdependency needed to serve the patient, the greater
the need for team collaboration`` (CHSFR 2006)
Working together…for healthy people in healthy communities.
![Page 43: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/43.jpg)
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
![Page 44: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/44.jpg)
Working together…for healthy people in healthy communities.
Where Next?
![Page 45: Saskatchewan Integrated Stroke Strategy: 2012 Evaluation Sunrise Health Region](https://reader033.vdocuments.site/reader033/viewer/2022051611/54b19f5e4a7959882b8b45f2/html5/thumbnails/45.jpg)
Working together…for healthy people in healthy communities.