Newsletter VII
November 2016
The South West Stroke Project is developing and implementing initiatives to improve outcomes for people with
stroke and transient ischemic attack (TIA). Phase I of the project is focusing on implementing
recommendations to realign inpatient acute and rehabilitative stroke care from 28 hospitals sites to 7
Designated Stroke Centres. The Phase II goal is to create recommendations to enhance secondary stroke
prevention, outpatient and community rehabilitation and stroke support services.
South West Stroke Project web pages
Click here to view the new South West Stroke Project web pages—a central resource for upcoming
education opportunities and tools to help you communicate about our Stroke Project work.
Phase I update
Implementing and evaluating the recommendations for the future of in-hospital stroke care
Local Stroke Working Group (LSWG) Updates
Project Consultant Sue Vollbrecht has joined the South West Stroke Project team to help the LSWGs with
their realignment implementation.
Huron Perth (HP)
In October HP LSWG completed their final readiness assessment and finalized their walk-in, emergency
and in-hospital code stroke protocols, and telestroke education.
In preparing for the increase in volumes, the
expansion of the Integrated Stroke Unit (ISU) at
Huron Perth Healthcare Alliance – Stratford
General Hospital (HPHA – SGH) is on target for
completion Dec. 1. “Managers at nondesignated hospitals have worked as part of the
Local Stroke Working Group to achieve a good
comfort level about the upcoming divestments,”
says Bonnie Thompson, Interim Manager,
Huron Perth District Stroke Centre. She adds
discussions are underway on surge planning
and planning for what to do in the event patients
are not able to get to a Designated Stroke
Centre due to bad weather.
Effective Nov. 1, patients with stroke who
receive tPA (tissue plasminogen activator)
treatment at Alexandra Marine and General
Hospital (AMGH) will be transferred to HPHA –
SGH’s ISU for the balance of their acute care
and, if required, inpatient rehabilitation. As well,
at HPHA – SGH telestroke is being used for
every acute stroke protocol to help familiarize
staff with the process.
Huron Perth Health Care Alliance – Stratford General Hospital
completed a mock-telestroke exercise Oct. 31, in preparation for
their telestroke go live Nov. 1.
Grey Bruce
Good working relationships and communication are supporting work between partners from South Bruce
Grey Health Centre and Hanover and District Hospital. Discussions are underway on the education plan
for physicians and nurses. The district’s 60-day readiness assessment is nearing submission, and a
meeting took place with Grey and Bruce EMS to review the Acute Stroke Bypass and Medical Redirect
Memorandum of Understanding. Patient volumes are being closely monitored. Joan Ruston Berge,
Manager, Grey Bruce District Stroke Centre, emphasized the importance of public awareness to the
success of the project. “Patients are very tied to their local hospitals, and they need to understand the
rationale for being transferred to a Designated Stroke Centre.” A communication strategy to reach out to
the public via media and other tactics is being developed.
Elgin Oxford Norfolk
The development of the Secondary Stroke Prevention Clinic (SSPC) at St. Thomas Elgin General
Hospital (STEGH) continues in a staged and gated manner, with the current focus on referral, diagnostics
and order sets for patients coming to the SSPC from emergency. To gain further knowledge about
SSPCs, members of the STEGH stroke team have completed site visits both within and outside of the
South West Local Health Integration Network area.
Tillsonburg District Memorial Hospital is transferring walk-ins to STEGH, as their gradual divestment of
stroke care continues. As well, following assessment and possible treatment with tPA at LHSC for eligible
patients, Tillsonburg area patients have begun to be repatriated to STEGH for the balance of their acute
care and inpatient rehabilitation (if required). Work on the repatriation process, walk-in protocols, and inhouse code stroke is ongoing.
London Middlesex Oxford (LMO)
The planned dates for divesting stroke services are:
 Alexandra Hospital in Ingersoll – late November
 Middlesex Hospital Alliance - Four Counties Health Services in Newbury – mid-February
 Middlesex Hospital Alliance - Strathroy Middlesex General Hospital – early March
 Woodstock Hospital – late March
London Health Sciences Centre – University Hospital (LHSC – UH) has identified plans for additional
beds. A stroke navigator position is now in place to streamline processes and patient flow between LHSC
(acute stroke care) and St. Joseph’s Health Care London’s Parkwood Institute (inpatient stroke
rehabilitation). This is a temporary pilot role jointly reporting to LHSC – UH and Parkwood Institute.
Walk-in protocols at the non-designated hospitals continue to be reviewed and refined. With both
Woodstock Hospital and Parkwood Institute providing inpatient rehabilitation for London Middlesex
Oxford, work is continuing on the algorithm based on patient needs to determine which patients from
Oxford County will receive inpatient rehabilitation at Woodstock Hospital, and which will receive it at
Parkwood Institute.
Emergency Medical Services
Conversations are continuing with the LSWGs and their respective EMS partners, about changes needed
to the draft Acute Stroke Bypass and Medical Redirect Memorandums of Understanding because of the
recent patient flow decision related to EVT (endovascular treatment). Briefly, this decision resulted in the
recommendations that St. Thomas Elgin General Hospital will remain a District Stroke Centre, but will not
provide tPA at the time of realignment. Patients eligible for tPA/EVT in Elgin, Oxford and Middlesex
counties will be assessed for both tPA and EVT at the Regional Stroke Centre at London Health Sciences
Centre – University Hospital. For more information on this decision see the October newsletter.
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Regional Stroke Dashboard
A quarterly dashboard has been developed to monitor 18 indicators across the continuum of stroke
care. The purpose of the dashboard is to measure performance, including capturing any unintended
consequences, during and post implementation. All hospitals are part of this dashboard. The metrics on
the dashboard are currently being refined and finalized as it will be a key resource in monitoring and
evaluating this transformative change.
Physician Advisory Group
The Physician Advisory Group welcomed Dr. Donald Lee, neuro-radiologist at LHSC, to their consultative
team which is responsible for advising on the best practices for stroke care and the highest standards of
medical care. This group is integral to developing the education plan and identifying minimum physician
(acute and inpatient stroke rehabilitation) competencies for the realignment of stroke services.
Phase I next steps
Phase I is moving into the execution stage as Huron Perth blazes the trail for the realignment of stroke services.
Readiness Assessments will validate preparedness for implementations in other districts such as London
Middlesex Oxford Stroke District’s planned start in late November and Grey Bruce in January. Risk mitigation
plans are being updated, evaluation reporting fine-tuned, and patient focus groups as well as patient outcome
measurement surveys designed to support the Phase I AIM statement to reduce stroke mortalities and improve
patient outcomes.
Communication to the public about stroke realignment in Huron Perth will take place via media releases and
other strategies from Alexandra Marine and General Hospital, Huron Perth Healthcare Alliance, Listowel
Wingham Hospitals Alliance, and South Huron Hospital Association in mid-November.
Phase I education update
The Emergency Departments of non-designated hospitals are identified as a priority on the Education
Plan. A planning committee
was formed in August to
determine the education
objectives, content,
promotion, and rollout. In
early October, these
sessions received
accreditation for Continuing
Medical Education (CME)
credits through the Royal
College of Physicians and
Surgeons of Canada and the
College of Family Physicians
Canada.
Dr. Bryan Young, Physician
Lead for the Stroke Project
Dr. Bryan Young conducting a videoconferenced education session.
and Attending Neurologist at
Owen Sound Hospital, is the speaker for the educational sessions. He is going to non-designated
hospitals in each stroke district, and videoconferencing to the other sites.
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These 1.5 hour sessions, being held in October and November, review the recognition of stroke and TIAs
and provide an overview of the proposed future state of the realignment of stroke care in the South West
LHIN.
The target audience for these sessions is physicians who are practicing in the Emergency Departments of
non-designated hospitals in the South West LHIN. Nurses, educators, administrators, and care providers
from family practice clinics are also welcome to attend. A collection of these sessions will be recorded and
archived for later viewing on the education web page. For more information, please contact Lyndsey
Butler, Regional Education Coordinator.
Visit the South West Stroke Project Phase I education web pages at http://swostroke.ca/swsp-phase1education/
Communication
Communication
Overarching materials to help communicate about stroke realignment in the South West LHIN, including a
PowerPoint presentation, fact sheet, elevator speech, and poster encouraging people to call 911 if they
think they’re having a stroke can be found here.
A plan for communicating publicly about stroke realignment
will roll out by stroke district; the first district is Huron Perth,
with media releases planned from the four hospitals in midNovember.
Newsletter survey results
The survey results indicated the most popular newsletter
features are the Phase I and Phase II updates and the stories
highlighting the stroke continuum of care, followed by articles
about education and stroke survivors. The survey results
showed 55% of respondents felt the newsletter length was just
right, and 45% found it too long. We will strive to keep the
newsletter’s content as succinct as possible; however, some
months there is a great deal of information to cover. If you
have any comments or suggestions about the newsletter,
please submit them by clicking here.
If you have any communication needs regarding stroke care
realignment in the South West LHIN, please send your request
here.
The 28 hospitals involved in the South West
Stroke Project, along with other
stakeholders such as the Community Care
Access Centre, are each creating a unique
poster that outlines what stroke realignment
means to their specific organization.
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Phase II update
Creating recommendations for the future of post-hospital stroke care
Here’s an update on the initiatives underway for the two project teams: the Community Rehabilitation for
Stroke Survivors (CRSS) Project Team and the
Secondary Stroke Prevention (SSP) Project Team.
Proposed key component workshops
The CRSS and SSP project teams held workshops in
October to solidify how some of the key proposed
components for new models of community stroke care
and secondary stroke prevention would be
operationalized. These proposed components were
created based on input from “blue sky” events in spring
2016, and with subsequent extensive consultations with
key stakeholders across the South West LHIN.
Stroke survivors and their spouses participated in the
workshops to share their experiences and provide input
and ideas.
At the workshops the project teams and key subject matter
experts discussed some of the key proposed components.
For the CRSS team, the three proposed key components
discussed for the new vision for community stroke care are:



Stroke survivors Dana Martel, top, and
Wes Reinhart with his wife Shelley,
below, shared their stories and provided
valuable input at the proposed
component workshops.
Early Supported Discharge
Specialized Intensive Rehabilitation Teams
Community Hubs
For the SSP team, the four proposed key components
discussed for the new vision for secondary stroke
prevention are:




Emergency Department Role
Secondary Stroke Prevention Clinics
Carotid Clinic
Community Hubs
At the workshop, significant progress was made to solidify
the structures required to support this new vision of
community stroke rehabilitation and recovery and
secondary stroke prevention, with the teams defining next
steps to prepare the directional recommendations.
Phase II CRSS and SSP Co-chairs Deb Willems, Margo
Collver and Gwenyth Stevenson, along with Project Team
members, have created the proposed components for
community rehabilitation and recovery and secondary
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stroke prevention. These are supported by data compiled by Dr. Matthew Meyer regarding the estimated
number of people with stroke and TIA who will require the services, geo-mapping to determine where the
critical mass of people with stroke and TIA are located, whether the services will be required in home or in
an outpatient clinic, in urban or rural areas, etc. Best practices are integrated into this data; for example,
for CRSS the number of home visits required and staffing to support same, and for SSP the best strategic
locations for urgent TIA/SSP clinics and community hubs.
Phase II next steps
The CRSS is holding further stakeholder engagement sessions by webinar on Nov. 15 from 11:30 am –
12:30 pm and on Nov. 21 from 3:00 – 4:00 pm. If you would like to join one of these webinars please
contact Margo Collver.
The Phase II draft Directional Recommendations will be complete by the end of November for
presentations extending from December through to March to the following tables in the South West LHIN:
Phase II Steering Committee, Community Support Services Council, Health System Funding Reform
Local Partnership, Chief Nursing Executives, CEO/CCAC Leadership Forum, and finally the South West
LHIN Board of Directors.
In the news
F.A.S.T. video promotion
Please continue sharing the 30-second F.A.S.T. video specific to your stroke district to encourage people
to call 911 if they experience the signs of stroke.
Stroke research and rehabilitation
Dr. Teasell speaks in Chatham about stroke research and rehabilitation.
Dr. Henry Barnett
Untold thousands of people owe their lives to Dr. Henry Barnett, the London neurologist whose
pioneering stroke-prevention research improved the health of patients around the world. Dr. Barnett
passed away in October.
Ontario’s second Stroke Survivor Congress held in Chatham
Attendees of Ontario’s second Stroke Survivor Congress, received the gifts of inspiration, insight and
information to improve the journey for current and future stroke survivors
New funding model to help manage high blood pressure
The federal government is experimenting with a relatively new funding model to kick-start a program
aimed at helping older Canadians in Ontario and British Columbia manage high blood pressure.
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The journey for people with stroke and TIA
Following people with stroke and TIA through the continuum of care.
District Stroke Centres
District Stroke Centres are the hub for planning, implementing, and improving all points in the stroke care
continuum in their district. Each District Stroke Centre has a coordinator or manager who collaborates
with district and local health care agencies and other partners on the District Stroke Work Plan, and
promotes/supports the implementation of stroke best practices across the continuum. District Stroke
Centres in the South West LHIN are located at:
 Grey Bruce Health Services – Owen Sound Hospital
 Huron Perth Healthcare Alliance – Stratford General Hospital
 London Health Sciences Centre – University Hospital; while LHSC is the Regional Stroke Centre (see
September newsletter) for all of Southwestern Ontario, including LHINs 1 and 2, it also serves as the
District Stroke Centre for the London Middlesex Oxford district.
 St. Thomas Elgin General Hospital
Examples of what a District Stroke Centre offers:
 stroke protocols for emergency services and acute care
 stroke order sets including TIA/mild stroke, tPA, ischemic stroke, hemorrhagic stroke, and admission
to inpatient rehabilitation unit
 standardized stroke scale to assess stroke severity
 secondary stroke prevention (SSP) clinic to assess and treat TIA/non-disabling stroke patients as well
as stroke survivors as clinically required (see June newsletter for more information on SSP clinics)
 24/7 computed tomography (CT) scanning and vascular imaging with expert interpretation
 clinicians with stroke expertise.
The District Stroke Centre:
 admits all stroke patients who will benefit to an acute stroke unit or an integrated stroke unit
 refers stroke survivors with a mild stroke who can be discharged home to a Community Stroke
Rehabilitation Team, specialized stroke outpatient program, or other community services such as the
South West Community Care Access Centre
 ensures all stroke survivors with a moderate to severe stroke have access to an inpatient
rehabilitation stroke unit (in some cases the District Stroke Centre also provides inpatient stroke
rehabilitation)
 partners with stakeholders across the stroke continuum of care including public health, primary care,
CCAC, community support services and long term care.
What’s the difference between a District Stroke Centre and a Regional Stroke Centre?
The Regional Stroke Centre for the South West LHIN, located at London Health Sciences Centre’s
University Hospital (see September newsletter), provides all of the services offered in a District Stroke
Centre, as well as:
 neurosurgical facilities
 interventional radiology
 endovascular treatment
Please see the following pages for highlights from each District Stroke Centre…
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District Stroke Centre at Grey Bruce Health Services
- Owen Sound Hospital
The District Stroke Centre at Grey Bruce Health Services - Owen Sound Hospital (GBHS – OSH) became
a provincial telestroke site in December of 2014. In May of 2015, a 4 bed acute stroke unit was opened
with a full interprofessional team supporting 217 stroke patients in 2015/16. The 5 GBHS rural hospitals
divested their stroke patients at that time in order to ensure they received care on the acute stroke unit.
Stroke patients receive priority admission to rehabilitation within 5 days for ischemic stroke. The
Secondary Stroke Prevention Clinic has seen an increase in volume of approximately 35 per cent and,
although it remains a part-time clinic, it has increased capacity to see patients 5 days per week. The
Community Stroke Rehabilitation Team is also witnessing an increase in volumes as the realignment of
services improves transitions and planning for patients and families.
Joan Ruston Berge
Manager, Grey Bruce District Stroke Centre
Some members of the GBHS – OSH Acute
Stroke Unit Team:
Back row: Errol Sturgeon; CCAC Care
Coordinator; Stephanie Hargrave, Speech
Language Pathologist; Wojtek Bergiel, OT;
Mandy Gillies, PT; Susan Kelly, Stroke NP; and
Linda Mailhot-Hall, RD.
Front row: Cassie Hilbert, RN; Diana
Williamson, Stroke Educator; and Kelly
Lougheed, ASU/Critical Care Coordinator.
Some members of the GBHS – OSH
Rehabilitation Stroke Team:
Back row: Laura Peters, OT; Natalie Kitts,
Therapeutic Recreation Specialist;
Heather Harvey, OTA; Sharon Morrissey, PT;
Nancy Alleyne, NRS coder; Samantha Bailey,
PT.
Front row: Lindsay See, Speech Language
Pathologist; Michelle Moreau, Social Worker;
Donna Boyd, RN; and Dr. Ann Fleming.
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District Stroke Centre at Huron Perth Healthcare Alliance
- Stratford General Hospital
To accommodate the increase in patient volumes that will come with realignment, preparations are
continuing to expand the Integrated Stroke Unit at Stratford General Hospital (SGH) by Dec. 1 from 8 to
13 beds. Of these 5 new beds, 2 will be for acute care and 3 for rehabilitative care. This newly expanded
unit will have the capacity to provide cardiac monitoring for patients and is complemented by the approval
on August 24 as a Telestroke Referring Site. “Education and communication plans as well as new
protocols related to telestroke, cardiac monitoring and changes resulting from the realignment of stroke
have been created in partnership with many stakeholders,” says Bonnie Thompson. “This will ensure
seamless and quality care for our patients.”
Bonnie Thompson
Interim Manager, Huron Perth District Stroke Centre
Some members of the Integrated Stroke Unit Team at HPHA – SGH:
Bonita Thompson Interim Manager of the Huron Perth District Stroke Centre; Karen Hoogenboom Pharmacist;
Kerri Hannon Interim Manager ISU; Angela Paulen, RN Team Lead; Nicole Nicholson, RPN; Courtney Robblee,
Rehab Assistant; Mark Hopkins, Physiotherapist; Deb Baer, RPN; Louise Flannigan, Stroke Strategy Nurse
Secondary Stroke Prevention Clinic; Nabiha Sharif, Occupational Therapist; Tina Gray, Speech Language
Pathologist; and Dr. Paul Lussier, Physician.
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District Stroke Centre at St. Thomas Elgin General Hospital
St. Thomas Elgin General Hospital opened its integrated stroke unit on April 4, 2016. 3 acute beds and 5
rehabilitative beds and a dedicated team of allied health professionals make up the integrated stroke unit.
In August, STEGH opened its Secondary Stroke Prevention Clinic in the first part of its staged rollout
which focuses on seeing stroke survivors discharged from the Integrated Stroke Unit. The clinic will see
clients with Transient Ischemic Attack (TIA) referred from the Emergency Department and community
providers over the next several months. Currently, the focus is on ensuring internal processes align with
current or in-development order sets and care pathways. These reflect stroke best practices and will help
ensure the best quality patient care.
Sandi Pincombe, Elgin/Oxford/ Norfolk District Stroke Centre Coordinator
Gwen Stevenson, Regional Prevention, and Thames Valley Stroke Coordinator
In the news
Some members of the Integrated Stroke Unit (ISU) team at St. Thomas Elgin General Hospital:
Back row: Sandi Pincombe, District Stroke Coordinator; Karen Telford, ISU RN; Christine Calhoun, Recreation
Therapist; Dawn Clinton, Recreation Assistant; Christine Thompson, Manager CCC & ISU; Vicky Kazmar, PT/OT
Assistant; and Mike Lalonde, Physiotherapist.
Front row: Julie Pridoehl, CDA; Kathy Kinsella, Social Worker; Trish Rodgers, Occupational Therapist; Marlene
Fortushnick, SLP; Sonia Colautti, Dietician; and Barbaranne Unrau, ISU RPN.
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