Stroke Care

The GTA Rehab Network, together with the three Toronto-area stroke networks, is leading a broad-based initiative to realign and improve stroke rehabilitation across the Toronto Central and GTA LHINs.

The initiative focuses on improving utilization of services, aligning care with best practices and enhancing outcomes. It reports to the Clinical Efficiency/Clinical Utilization Task Force of the Toronto Central LHIN and now includes representatives from the Central West and Central LHINs.

Reallocating resources

In phase one of the initiative, conducted in 2010/11, acute care and rehabilitation task groups conducted an extensive review of data and evidence and recommended that stroke resources be reallocated across the system.

All acute and rehabilitation hospitals were provided with organization-specific gap analyses and recommendations over the summer. They support the initiative and are working with the Networks to achieve the following goals:

• Consolidate acute stroke programs to align with critical mass thresholds
• Refer and admit stroke patients to rehab earlier
• Admit a greater number of patients post severe stroke into high intensity rehab
• Reduce the number of severe stroke patients being admitted to low intensity rehab programs, and
• Redirect patients with mild stroke to outpatient rehabilitation programs post acute care discharge.

Implementation Underway

Implementation is moving forward in several areas. The Networks are working with emergency departments and Emergency Medical Services (EMS), with specific focus on:

• Addressing non-emergency management of patients and processes to facilitate transfer of walk-in patients to nearest stroke unit when outside of the tPA window
• Reviewing current transfer processes/protocols for patients who walk-in to emergency but are within the tPA window
• Proposing recommendations for changes to EMS software, and
• Addressing public awareness relating to the transfer process between acute sites.

The Networks are also meeting with stroke physiatrists, service coordinators and clinicians from acute care and rehabilitation hospitals to determine what supports are required to move forward with earlier rehab referrals and transfers. They are also exploring what educational support organizations will require to make these changes.