Hyperacute
Less than 15 minutes.
This is a Canadian Stroke Best Practice key quality indicator/ metric/ benchmark.
How does the health care team routinely manage venous thromboembolism (VTE) risk?
VTA risk is assessed on admission.
Prophylaxis is ordered according to diagnosis.
This is a Canadian Stroke Best Practice and Required Organizational Practice.
What are resources provided to patients/families to support stroke understanding and recovery?
Examples:
- internal/ external resources are available on sunnybrook.ca
- education on modifiable risk factors
- emotional support and counselling provided by social workers, spiritual care, and psychiatric consult
- Access to the Regional Stroke Best Practice Team
- Discharge Summaries providing an overview of their hospitalization, interventions, care plan, and follow-ups
Sunnybrook is a part of the Toronto Stroke Network (TSN). Which region is our hospital a part of?
Sunnybrook is the comprehensive regional stroke center in the North & East GTA Stroke Network (NEGTASN).
Together we TSN, we are responsible for providing leadership in the development, implementation and coordination of stroke care throughout the region and across the continuum of care.
What is the door-to-needle target time?
Less than 30 minutes of arrival.
This is a Canadian Stroke Best Practice key quality indicator/ metric/ benchmark.
How does the health care team routinely manage falls risk?
Falls risk are routine assess using a validated screening tool - Morse Fall Scale. This is completed on admission to the unit, changes in status, and post-fall.
This is a Canadian Stroke Best Practice and a Required Organizational Practice.
How does the health care team address diverse communication, language and literacy needs?
Examples:
- Translation services
- Data on prevalent languages spoken
- Aphasia-friendly communication strategies
- Corporate Patient and Family Advisory Council
What information systems are used to continually monitor and plan for improvements in stroke services?
Examples:
- As a member of the Toronto Stroke Network, we complete yearly Standards of Care Self-Assessments
- CorHealth Ontario Stroke Evaluation report cards
- Ontario Community Health Profiles Partnership census provides population health data about our communities
What is the door-to-puncture target time?
Less than 60 minutes.
This is a Canadian Stroke Best Practice key quality indicator/ metric/ benchmark.
How does the health care team screen for nutrition?
In the NVU, nurses complete the Canadian Nutrition Screening Tool (CNST) within 24 hours of admission. Patients identified as high risk for malnutrition are escalated to the Registered Dietician for timely consult.
The Guide to Stroke Recovery
How does the stroke program collaborate locally with community partners?
Examples:
- Support accessibility to timely stroke services for our community partners (e.g., NYGH, SHN)
- Lead development, implementation, and coordination of stroke care - stroke best practice outreach, research
- provide emergency medical management of stroke/TIA - paramedic services bypass protocols, TIA and second stroke prevention services
- QI projects based on program and patient needs
What is the door-to-revascularization target time?
The door-to-revascularization target is less than 90 minutes.
This is a Canadian Stroke Best Practice key quality indicator/ metric/ benchmark.
How does the health care team screen for smoking cessation?
All patients are asked about smoking history. Patients express interest to quit smoking can be referred to the Rapid Access Addiction Medicine (RAAM).
How does the stroke team provide patient/family education across the health care continuum?
Example:
The Stroke Education Achievement (SEA) Tool was recently implemented between NVU and SJR - inpatient stroke rehab. As a team provide tailored education based on patient/family readiness to learn and learning goals.
How do we ensure stroke program services are aligned to Sunnybrook's Strategic and operational plans?
Examples:
- The stroke program integrates Sunnybrook's 2021-2025 Strategic Plans by implementing best practices, supporting high-performing teams through education.
- Our initiatives are also aligned with Sunnybrook's Annual Quality Improvement Plan, e.g. we review the digital Patient Experience survey data, provide concordant care.
What is the neuro IR procedure that involves the mechanical removal of a blood clot from a large cerebral vessel?
Endovascular Thrombectomy (EVT)
How does the health care team screen for depression?
In the NVU, depression screening is conducted by the social worker with a validated screening tool (e.g., HADS, PHQ-9, SADQ-10).
On Sunnybrook's public-facing website, how can patients/families access stroke resources?
"Navigating MyCare for Stroke" on sunnybrook.ca
How do we monitor our stroke program services?
Examples
- We PowerBI to gather stroke service data metrics/ key quality indicators
- Patient and Family digital survey to inform opportunities for improvement