New specialized rehabilitation services for stroke survivors are now being delivered on an out-patient basis as part of the second phase of the provincial Organized Stroke Care Model, announced Minister of Health and Wellness Doug Currie.
“In 2009, Government made a commitment to establishing an Organized Stroke Care model for the province to address the gap in coordinated stroke care services,” said Minister Currie. “The addition of ambulatory stroke rehabilitation services furthers the work our health care providers are doing in hospital-based stroke care by providing stroke survivors with the necessary out-patient supports to allow them to regain as much independence as possible.”
The Organized Stroke Care model’s second phase includes the establishment of a provincial ambulatory stroke rehabilitation clinic, ambulatory (or out-patient) stroke rehabilitation teams at both the Queen Elizabeth and Prince County Hospitals (QEH and PCH), and the provincial expansion of stroke prevention services.
“Rehabilitation helps stroke survivors re-learn skills that are lost when part of the brain is damaged by a stroke. The types and degrees of disability that follow a stroke depend on which area of the brain is damaged and how much is damaged,” says Dr. Ed Harrison, Physiatrist and Director of Physical Medicine and Rehabilitation at the QEH. “The availability of consistent and coordinated ambulatory stroke rehabilitation services is vital in maximizing recovery for a stroke as we are able to tailor the intensity and frequency of rehabilitation care to meet their needs. Equally important is our ability to offer this care in the most appropriate setting – whether that is on an in-patient or out-patient basis at either QEH, PCH, or through community-based services if available.”
The foundation of provincial ambulatory stroke rehabilitation services is the provincial ambulatory stroke rehabilitation clinic located at the QEH. The clinic functions as a consultative service providing assessment and follow-up to ensure stroke survivors receive appropriate services. The ambulatory stroke rehabilitation teams at QEH and PCH provide intensive therapy enabling an early supportive discharge program for patients discharged from the provincial acute stroke and stroke rehabilitation units at the QEH.
Each patient referred to the provincial ambulatory stroke rehabilitation program is assessed by an interdisciplinary team with expertise in stroke rehabilitation to determine the most appropriate treatment plan and is prescribed a treatment schedule accordingly. Rehabilitation care can be provided at a number of locations based on the type and intensity of rehabilitation required to maximize recovery. Treatment plans aim to improve:
• Arm and hand function
• Balance, mobility and transfers
• Self-care tasks such as getting dressed
• Speaking and understanding others
• Swallowing
• Other daily living activities that require improvement for functional independence
Also included in the second phase is the establishment of provincial stroke prevention services which is targeted for completion in 2013. Currently, a secondary stroke prevention clinic is offered at PCH.
Planning for the third and final phase of the provincial Organized Stroke Care model – the establishment of community re-integration services – is expected to commence this year.
Since 2006, many components of organized stroke care have been implemented including emergency stroke protocols and bypass agreements, administration of t-PA clot busting drug, provincial acute stroke unit, enhanced in-patient and out-patient rehabilitation services and a Secondary Stroke Prevention Clinic. A preliminary analysis shows improved quality of stroke care has reduced in-hospital complications such as pneumonia and reduced deaths. Other benefits achieved include decreased wait time to access stroke rehabilitation and decreased hospital length of stay.
Background:
Stroke is a leading cause of death and disability. In Prince Edward Island, there are approximately 350 strokes annually – this equals about one stroke every day.
Phase One of the Stroke Strategy established the early intensive rehabilitation services on the Acute Stroke and Stroke Rehab Units at the QEH. Phase One was implemented in the spring of 2010.
Phase Two has allowed early supported discharge to intensive out-patient rehabilitation, consistent with Canadian Best Practice Guidelines. Implementation of the second phase began in November 2011.
Phase Three will extend rehabilitation and secondary prevention services to the community level.