By BIRGIT LACEY
When asked about the benefits of Bluewater Health’s new model for acute stroke care, members of the care team (pictured) agree: “The results are impressive,” says Nancy Hubbard, charge nurse, Acute Stroke and Telemetry Medicine Unit. “We’re seeing much better patient outcomes because of the combination of changes we’ve made.”
“It can be challenging to establish and sustain specialty stroke care in smaller communities,” says Linda Dykes, manager, Sarnia Lambton District Stroke Centre. “We tried different models, but since heart disease and stroke are both vascular diseases, we found that for us, partnering with the cardiac Telemetry Medicine Unit to deliver acute stroke care works best.”
Clustering care for vascular conditions has benefits for patients and care providers. “Receiving care on a specialized stroke unit, from an inter-professional team with expertise in stroke, has been shown to significantly improve a person’s survival and recovery following a stroke,” adds Dykes. ”Through this model, we have enhanced our ability to identify potential causes of the event and then determine the most appropriate actions to minimize future risk. We can flex our resources within the Telemetry Unit to care for both cardiac and stroke patients.”
The care really begins when patients present in the Emergency Department with signs or symptoms of stroke. “We don’t wait for the patients to come to the stroke unit,” says Angela Small Sekeris, stroke clinical nurse specialist. “Our admissions nurse in the emergency department, Liz Anthony ensures that all aspects of the stroke protocol have been initiated. This includes care by the inter-professional stroke team right in the Emergency Department. Having members of the stroke team involved right from the Emergency Department through to the Acute Stroke Unit provides reassurance to patients and families there is continuity of care.”
Most patients with a new diagnosis of stroke in Sarnia-Lambton are admitted to Bluewater Health’s Acute Stroke Unit, comprised of six beds at the Sarnia hospital. In the 2011/2012 fiscal year, 241 people were admitted to hospital after presenting to the Emergency Department with stroke symptoms. Now in its second year, the focus is on reviewing and refining processes, and enhancing staff expertise to provide the best in stroke care, guided by the Canadian Best Practice Recommendations for Stroke Care. This work aligns with Bluewater Health’s focus on best practices through its three-year candidacy in the Registered Nurses’ of Ontario’s Best Practice Spotlight Organization initiative.
Adding to the unit’s success is the recent implementation of the National Institute of Health Stroke Scale across the acute care continuum. It is a meaningful assessment tool for everyone along the patient’s care journey and provides consistency in communicating information. “It allows us get a more accurate picture of the patient’s condition and progress, from presentation right through to discharge,” says Anthony.
“Everyone who participates in delivering stroke care, in the Emergency Department, Telemetry Medicine and Cardiac Care, received training on the tool, which was crucial,” says Small Sekeris. This enhanced communication is furthered by daily team rounds, involving Nursing, Occupational Therapy, Physiotherapy, Communicative Disorders, Nutrition and Food Services, Pharmacy, Social Work, and Community Care Access Centre, to discuss priorities based on those assessments. “We can identify who is improving and ready for discharge home, or to the inpatient Rehab Unit, what resources patients might need, and any concerns raised by patients’ families,” says Hubbard.
“The team is really making a difference – it’s crucial,” concludes Small Sekeris. “All members look for opportunities to enhance the care of our stroke patients, and improve their treatment and recovery.”
Bluewater Health has been selected to share the successes of its clustered Acute Stroke Unit at the Canadian Stroke Congress in Calgary this fall. The Canadian Stroke Congress is a joint initiative of the Canadian Stroke Network, the Heart and Stroke Foundation of Canada and the Canadian Stroke Consortium. “We are very proud of our achievements and we’re excited to share our successes and challenges with other health centres across the country,” says Dykes.