Search

Background: Stroke Endovascular Therapy (EVT) is a highly specialized neurointerventional procedure provided at regional or tertiary level stroke centres. It requires a regional approach, building on existing local thrombolysis protocols to ensure timely referral and transfer for EVT. Within Central South Ontario, half of the EVT patients treated at the regional EVT centre are from referring sites. As a result, it is imperative to develop a regional drip and ship protocol to support the safe and timely transfer to the EVT centre and minimize delays to transfer. Methods:Consultation with local EMS providers identified the necessary protocols required to support safe transport. An environmental scan of existing Drip and Ship Protocols was completed. Representatives from referring thrombolysis centres were brought together to develop a regional drip and ship order set to support the safe transport of EVT patient who receive IV thrombolysis (tPA )and those who have not received IV tPA to the endovascular centre. Results:Local drip and ship protocols were developed that addressed: 1) EVT pre-procedural orders; 2) vital sign and neurological monitoring: 3) monitoring and management of tPA complication; 4) management of contrast dye allergic reaction; and 5) other symptom management on route. In addition to the Drip and Ship Order sets, centres developed EVT Transport Order Sets, Patient EVT Transfer Policies, EVT Transport Checklists; EVT Transport Medication Kits and Transfer Documentation Records. Conclusions:Collaborative development of a regional drip and ship process has supported the safe transport of regional EVT cases and limited delays to treatment.

Background: The Central South Regional Stroke Centre is the stroke endovascular (EVT) provider which provides stroke care to 2.3 million residents. Five referring thrombolysis centres identify and transfer potential EVT candidates to the EVT centre for treatment. In order to manage the increasing EVT volumes at the regional EVT centre, it is imperative that there is timely repatriation back to the local acute stroke units for ongoing stroke management. Methods: As the Regional Stroke EVT Algorithm was developed with the referring centres, the structures to support repatriation were explored. The existing Acute Stroke Bypass Memorandum of Understanding (MOU) guided the repatriation process for stroke thrombolysis patients but did not include EVT patients. A provincial Life and Limb Policy (LOLA) existed to facilitate the transfer of patients with life or limb threatening conditions to the tertiary care hospitals within 4 hours and supported the repatriation back to the sending centre within 24 to 48 hours when stable. It was determined that the provincial LOLA policy would provide the structure to support the timeline repatriation of EVT patients.Results: The repatriation to the home stroke centre is initiated when the patient was discharged from the level 2 stepdown unit with the expectation this transfer occurs within 24 hours. In FY 2017/2018 December YTD, the average time from repatriation was 24 hours. Conclusions: Working with referring stroke thrombolysis centres and supported by a provincial LOLA policy has allowed for timely repatriation back to home stroke centre post EVT for ongoing stroke care.

BackgroundThe Agency for Healthcare Research and Quality (AHRQ) defines the goal of working with patients and caregivers as bringing their perspectives into care planning, delivery and evaluation through sharing insights based on their identified needs and experiences (u201cWorking with Patients and Families as Advisorsu201d, AHRQ, 2008). Engaging the patient and caregivers in healthcare has become essential practice in stroke systems planning. Within the Central South Regional Stroke Network, individuals have been engaged through committee membership, community events and strategic planning. Recognizing the need to continue this engagement based on the networku2019s strategic direction, a project was initiated to formally integrate the patient voice, through forming a regional patient and caregiver advisory council. ObjectiveTo describe the planning, recruitment and launch of a regional patient and caregiver advisory council.MethodsGroups of nursing students were engaged and completed literature reviews and interviews with advisory councils locally/provincially. This work focused on defining the patient experience, gathering evidence for councils and examples of council structure and function. Local patient experience experts were also consulted. This work has provided the structure for the recruitment process, volunteer description and draft terms of reference. Conclusion Integration of patient and caregiver voices is vital as the network strives to implement stroke best practices across the continuum of care, while remaining patient-centred. The process of launching an advisory council has involved literature review and expert consultation. Further results regarding the councilu2019s cross-region structure and future directions will be described after the councilu2019s inaugural meeting in spring 2018.