The period of time from when a person calls 911 to arrival to the Stroke Centre Emergency department is often referred to as the Hyperacute period. All patients with suspected acute stroke would receive rapid assessment and undergo brain imaging on arrival to determine eligibility for the intravenous drug tPA (tissue-plasminogen activator) also known as the “clot buster”. Administration of tPA soon after onset of symptoms can limit irreversible ischemic damage.

A new procedure: Endovascular Therapy (EVT) can sometimes be an option for patients with large artery ischemic strokes. There are 2 EVT centres in the Southwestern Ontario Stroke Network region that perform this specialized procedure: Windsor Regional Hospital – Oulette Site and London Health Sciences Centre – University Hospital. This procedure is available to appropriate candidates 24/7 at University Hospital. This youtube video shows how the procedure is performed: https://www.youtube.com/watch?v=0DQPD5TTS5Y

Patients with an acute stroke or transient ischemic attack would be admitted to a stroke centre and receive care on an inpatient stroke unit. A Stroke Unit is a geographically defined hospital unit dedicated to the management of stroke patients [Evidence Level A]. This unit is staffed by an interdisciplinary health care team who provide coordinated, best practice stroke care. Stroke patients who receive stroke unit care are more likely to survive, return home, and be independent than stroke patients who receive less organized, general ward care (Stroke Unit Trialists’ Collaboration 2009).  Stroke Units can be classified as Acute, Integrated (combination of acute and rehabilitation stroke beds), or Rehabilitation Stroke Units.

The Regional Stroke Centre and every district stroke centre within the Southwestern Ontario Stroke Network region offers specialized acute stroke care on either an acute stroke unit or an integrated stroke unit.

• Windsor Regional Hospital – Oulette Site: Acute Stroke Unit
• Bluewaterhealth – Norman Site: Acute Stroke Unit
• Chatham Kent Health Alliance – Chatham Campus: Integrated Stroke Unit
• Grey Bruce Health Services – Owen Sound Site: Acute Stroke Unit
• Huron Perth Healthcare Alliance – Stratford General Hospital: Integrated Stroke Unit
• St. Thomas Elgin General Hospital: Integrated Stroke Unit
• London Health Sciences Centre – University Hospital: Hyperacute and Acute Stroke Units

Telestroke is an emergency telemedicine application using videoconferencing technology. Telestroke sites can provide assessment and treatment of patients experiencing acute stroke via consultation with a provincial Telestroke neurologist. The neurologist can view the patient’s CT scan electronically, “see” the patient using live video and discuss results with the patient’s physician. In the Southwestern Ontario Stroke Network region, there are currently 4 telestroke sites providing telestroke services: Alexandra Marine and General Hospital, Goderich; Bluewater Health-Norman Site, Sarnia; Huron Perth Health Care Alliance – Stratford General Hospital, Stratford; and Grey Bruce Health Services – Owen Sound Site, Owen Sound.

• Approximately 80% of strokes are ischemic and 20% are hemorrhagic
• 55% of acute stroke patients have dysphagia in the first few days following a stroke

• Canadian Best Practice Recommendations for Stroke Care – Hyperacute Stroke Care
• Canadian Best Practice Recommendations for Stroke Care – Acute Stroke Care

Stroke Assessment Tools:

• The Canadian Neurological Scale (CNS), or
• The National Institutes of Health Stroke Scale (NIHSS)
• Understanding Alberta Stroke Program Early CT Score (ASPECTS)

Reports, Presentations, Posters, and Handouts specific to the Southwestern Ontario Stroke Region

Posters:

• Development of a Hyperacute Stroke Unit at London Health Sciences Centre, Regional Stroke Centre (2014 Canadian Stroke Congress)
• In-hospital Code Stroke Protocol Ensures Faster Access to Hyperacute Stroke Care (2015 Canadian Stroke Congress)
• tPA Nurse Role Impacts Hyperacute Stroke Care at University Hospital (2015 Canadian Stroke Congress)
• Building a Stroke Unit Toolkit…..A Phased-in Approach (2016 Canadian Stroke Congress)

EMS Newsletters featuring stroke articles:

• July 2012: Timely Access to Best Practice Stroke Care (page 11)
• October 2012: Stroke Patients – Last Seen Normal Time (page 7)
• July 2013: New Hyperacute Canadian Best Practice Recommendations for Stroke Care…Highlights for EMS (page 10)

For more information about Acute Care Best Practices related to stroke in the Southwest Region or any of the above, please contact:

Gina Tomaszewski
Regional Stroke Acute Care Coordinator
Southwestern Ontario Stroke Network
University hospital, London, Ontario
gina.tomaszewski@lhsc.on.ca
519 685-8500 ext. 35268