Making stroke care better in Waterloo Wellington. DRAFT 1 ( ) Fall 2013

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1 DRAFT 1 ( ) Fall 2013 Making stroke care better in Waterloo Wellington The Waterloo Wellington Rehabilitative Care Council Improving stroke care in Waterloo Wellington, fall 2013, page 1

2 Since 2011, health service providers in Waterloo Wellington have worked together to improve rehabilitative and stroke care for area patients. Care providers work hard on behalf of patients. However, the rehabilitative care system including stroke care- doesn t meet patients needs. The Waterloo Wellington Local Health Integration Network (WWLHIN), in partnership with health service providers, did a review of regional rehabilitation services as well as stroke care. The review in 2011 found ways to increase access to care and provide better outcomes for patients and their families. We have also spoken with stroke survivors, their family members as well as community groups across Waterloo Wellington. We ve proposed changes to make care better, which are now coming into effect. We want to tell you what we ve done, what we ll do and how we want to keep improving care for patients and families. Regional partners in better care... Improving stroke care in Waterloo Wellington, fall 2013, page 2

3 By April 2014, Waterloo Wellington will have a new integrated stroke program. It will provide best practice care, help to coordinate the work of health service providers and offer better support for patients through their stroke care and as they go back to the community. Why are we making changes? About 870 patients a year in Waterloo Wellington experience a stroke. In community consultations, patients told us about feeling a lack of support when their hospital stay is done and they go back to the community. In the past, care providers have also talked about barriers that prevent patients from receiving the best care. Care practices have been inconsistent from hospital to hospital and outcomes have been below provincial standards. How have we done to date? Waterloo Wellington hospitals and the Community Care Access Centre have come together to make major changes to improve care for patients. Some successes to date include: Setting up an integrated clinical program for all stroke services in Waterloo Wellington. This ensures all stroke patients have timely access to stroke care based on the best evidence and practices no matter where they live or receive their stroke care; New monitoring and quality improvement steps to make sure changes are leading to better outcomes for patients; Streamlined referrals for stroke patients to inpatient rehabilitative care for faster access to recovery services while getting rid of paperwork for providers; and Improved access to community stroke services (outpatient rehabilitative care, aphasia services, stroke recovery support groups and community support services) when a patient is discharged from hospital. We re developing new websites like Care Dove ( to Improving stroke care in Waterloo Wellington, fall 2013, page 3

4 connect stroke patients with community-based programs to continue their recovery. We have seen the following improvements so far: Stroke-related mortality rates have improved and are now better than the provincial average; The proportion of severe stroke patients moving to rehabilitation has improved (from 27.4 per cent in 2010/2011 to 36.8 per cent in 2011/2012); and Acute stroke alternate level of care hospital days have declined from 36.9 per cent in 2010/2011 to 31.8 per cent in 2011/2012. an integration of stroke services throughout Waterloo Wellington. Next steps for the integrated stroke program include the following: The expansion of emergency stroke services to include Guelph General Hospital (GGH) as a telestroke supported site. This will give more patients timely access to the clotbusting drug tpa. Proposed changes would see ambulances bringing Waterloo Region patients to Grand River Hospital (GRH) in Kitchener and North Wellington patients to GGH. Time is brain is vital in stroke care, and faster access to clotbusting drugs will result in improved patient outcomes; All stroke patients will receive care in specialized acute stroke units at Grand River Hospital in Kitchener and Guelph General Hospital. Right now, What are our next steps? In August 2013, the Waterloo Wellington Local Health Integration Network approved Improving stroke care in Waterloo Wellington, fall 2013, page 4

5 the only dedicated stroke unit is at GRH, with other area hospitals offering stroke care (but not within dedicated units); and Ensuring access to dedicated stroke rehabilitation for all patients. This is to ensure the best outcomes and function after a stroke. Patients who need inpatient rehabilitative care services will receive specialized stroke rehabilitation at Cambridge Memorial Hospital, Grand River Hospital s Freeport Site and St. Joseph s Health Centre Guelph. These sites are launching stroke rehabilitation best practices to help improve recovery for stroke patients. These changes will take place by April How will we measure results? The stroke system will pay close attention to the following key areas to determine the effectiveness of improvements and to match changes happening across Ontario: Ensuring all stroke patients are served in specialized acute stroke units. Patients have better outcomes when they receive care in specialized stroke hospitals; and Additional information and contacts For more information, please contact Melissa Kwiatkowski (Melissa.Kwiatkowski@sjhcg.ca), Emmi Perkins (emmi.perkins@sjhcg.ca), or Jennifer Breaton (Jennifer.breaton@grhosp.on.ca) Care Dove is a tool to improve access to community-based rehabilitative care services and programs. It will help patients with functional goals to be matched with community programs. Visit for more information. Improving stroke care in Waterloo Wellington, fall 2013, page 5