Improving Access to Quality Stroke Care in Waterloo/Wellington. May 11th, 2013

Transcription

1 Improving Access to Quality Stroke Care in Waterloo/Wellington May 11th, 2013

2 Why is this happening? We want to make rehabilitation better for patients across Waterloo and Wellington The stroke stream is part of a broader rehabilitation review There are three other aspects to this review, covering Musculo skeletal care Care for the frail elderly Cardio pulmonary care This involves hospitals and health providers from across Waterloo and Wellington

3 Stroke is a system of care We need to prevent strokes, treat them as quickly as possible, provide timely access to rehabilitation and help people as they go home.

4 What is/isn t working now? We have great providers who do their very best for patients. The stroke system in Waterloo and Wellington has too many pieces in too many places. There aren t consistent ways of caring for people There isn t a way to give patients access to the best specialists all the time, no matter where they live. We can do better, and improve outcomes for patients.

5 What do we propose? To develop a stroke system that has better results for patients and families Access to specialized, timely stroke care for all stroke patients in Waterloo and Wellington Concentrate stroke beds to make sure patients have the best access to the care they need (critical mass) Develop designated stroke units with dedicated stroke staff receiving the latest training to give patients the best results Partnerships with the Community Care Access Centre and other community stakeholders to help patients when they recover at home

6 Preventing strokes and acting faster We need families/friends to recognize the signs and symptoms of stroke, recognize this is a medical emergency and call right away: Sudden weakness Trouble speaking Vision problems Headache Dizziness EMS can get patients to care faster, and ensure faster access to clot busting drugs (when appropriate)

7 Changing the care system for the better Care in an emergency will remain the same. People will continue to go directly to Grand River Hospital in Kitchener for assessment for clot busting medications. We continue to review whether other sites should be equipped to provide this therapy. Inpatient acute and rehabilitation stroke unit care will be consolidated to create critical mass We are finalizing and refining where the services will be located Working with CCAC to develop a model of care for better

8 CUrrent Location of Stroke Service5 in WWLHIN 1 -"11- District stro<e center- Acute [thrombolysis) District stro<e center- Rehab site Acute

9 New Model of Stroke System of Care in Waterloo/Wellington LHIN Recommended by WW Rehab Council Acute Stroke Care 2 Geographically Defined Stroke Units with dedicated staff waterloo_map.ln Inpatient Rehabilitation 3 Geographically Defined Stroke Rehab Units with dedicated staff

10 This is a big change. Why is this better? Ontario Stroke Reference Panel has put forth province wide recommendations for : Specialized Stroke Units Early admission to rehabilitation Intensity of therapy 7 day a week admission 7 day a week therapy Access for severe stroke Outpatient rehabilitation Putting specialized resources in a few large sites allows us to provide better care.

11 Critical mass: bigger is better for patients Stroke Expert Panel recent recommendations (Feb 2013) to achieve the critical mass of expertise and stroke unit admissions, each LHIN will need to consider consolidation of stroke care in a few number of hospitals in their region. Thus, stroke related bed days will be moved from smaller centres to those with stroke units.

12 Faster access to rehabilitation: better outcomes for patients Day 5 for ischemic stroke, Day 7 for hemorrhagic Time is brain for acute stroke; but time is function for rehab!

13 What changes we can make now? Applying a consistent banding approach making sure we clearly identify stroke patients for their needs, so we can act on those needs faster Hiring a stroke navigator in May to assist with seamless, timely transitions Putting in place best practice clinical pathways to standardize care provided across the continuum of care

14 Stroke Navigator Anticipate the needs of stroke patients within the system Ensure appropriate referral and placement of stroke patients Ensure capacity and flow across the continuum of the stroke system Develop transitional and discharge plans Ensure the right patient receives the right care at the right time through management of wait lists

15 Make acute care work better for patients Staff education surrounding best practices Patients automatically transition to rehab (no application) Expanding care plan to reflect best practice (e.g. oral care, continence assessment, etc) Improving access (move to 7 day a week care model for therapy, transfers and discharges) Currently a 5 day a week model Documentation doing the right thing but remains a challenge to capture it and flow across and between sites

16 Making rehabilitation better for patients New system changes include: Getting faster rehab access (inpt & outpt) Improve access for severe stroke patients getting to inpatient rehab Longer and more intensive therapy (move to 3 hrs/day 6 7 days a week) Currently patients receive an average of a little over 1 hour of therapy per day 5 days per week Specialized stroke rehabilitation units with dedicated teams (nursing, allied health, medical)

17 What will our communities gain? A stroke patient s time in hospital is short. Their time at home is longer. Ensure that patients are embraced and supported with an appropriate community resource when they return to their community Work with stream lead organizations to develop the community services sector of the standardized care paths Develop trust and capacity in the system to ensure patients get the right care, at the right time, in the right place Link with primary care to ensure that they have information regarding the availability/processes to access community services

18 Community Planning Community Integration Teams

19 .}Ht>l My Organizations My Appointments My Groups Welcome joe bornlo I My Account I Sign out WATmLOO -WELLINGTON REHAB!LITATIVE CARE Home Address ( 10 St. Patrick Street Fergus Ontario ) e!ec1Category advanced powered by Csredove Museui6Skelatal \r Ortho Rehab ()'"Sports Injury Rehab ()'Motor Vehicle Accident Rehab -Urinary Rehab Neurological 0Stroke Rehab ef Aphasta Rehab v' Speech Language Therapy- Home _1 Spinal Cord Injury Rehab Cardiopulmonary J Cardiac Rehab 0 Pulmonary Rehab 0 Fitness Centres Frail Elderly 0Gentle Exercise usenior Day Program () Caregiver Supp-ort Groups..) Overnight Respite wanness 0 Weight Management =! Assistlve Devices 0 Fitness-Centres ') Aquafit Programs 0 Fitness Classes J Telephon.e Reassurance & Safety Checks O+Home Supportive ' ABIRehab r SeatehResulls J *My Favorites(1)1 D lit Home Speech Therapy ProVIded to your home D Pathology more ll'fo F eo rross Care Partner.: Formerly DTS home ad<lress + or search:( In Home Speech Language Pathology View full listing tp. :.:::; a Home Speech Therapy Elmria Road North,Guelph Ontario oaullne.woodall@redcrosscarepartners ca Provincial Pa.l1t X I Map I Satellite I Albio n Hills Conservation Area Arthur Cost: $80 per hour ReferralPhone: View all referral info (9 Apponi tment Booking Avaliabl e '" VIew fullllstino Hear t Lako Conservati Area Brarr Hatton Hills Georgetown

20 Features of WWCCAC Proposed Stroke Rehabilitative Care Model 1. Designated hospital and community care coordinators to support client transition to home and/or community programs; and work closely with Stroke Flow Navigator. 2. Discharge Link meeting with most responsible community clinician, hospital team, and hospital care coordinator. 3. Most responsible community clinician to make first treatment visit to client within 7 days of hospital discharge. (Phase 1 and 48 hours Phase 2) 4. ONE community service provider for all disciplines to facilitate development of skills in stroke treatment and inter disciplinary communication. 5. Improved linkage with primary care

21 Working Groups across the Continuum What s a care pathway? Why does it matter?

22 Integrated care pathway It s a way of knowing every step of a patient s care when they have a stroke. We can then respond faster and better to their needs at a given point. Six groups across continuum are mapping out the patient journey They re working with the identified clinical experts to develop a better system that will be more responsive to patients, whether they re in an ambulance, in hospital or back at their homes

23 What is the timeline for change? March and April: consult with communities April: hospitals/health providers to consider the changes June: decision by LHIN Board Full implementation of changes to be completed in

24 Discussion What s important to you for stroke care? What do you think about what you ve seen? Do you have questions/concerns that you would like followed up on? How do you want receive updates/information moving forward

25 Better Health A Better Rehabilitative Care System