Bob is an active Vancouverite in his sixties, managing high blood pressure and diabetes. In the winter, he hits the ski slopes in Whistler; in the summer he loves fishing in Powell River. But, he’s not a real person. Bob is the example leaders have been talking about to redesign how we treat stroke patients across the region.

“Of our 13 acute care sites, we have a mix of sites that are considered remote, rural and urban,” says Sacha Arsenault, regional lead for health services integration and stroke strategy. “Instead of every site providing the same level of stroke care, we are looking regionally at where we can build up our services, and where we should work closer with BC Ambulance and the BC Patient Transfer Network to improve the transfer process for patients having a stroke.”

Transfer time is critical if a patient is having an ischemic attack, the most common form of stroke when a clot blocks the blood supply to part of the brain. Patients need to be assessed and receive the drug tPA (tissue plasminogen activator) within four and half hours to break up the clot and restore blood flow.

In 2012/13 there were 2, 460 admitted stroke cases across VCH, with Vancouver General Hospital treating 56 per cent of these patients. Since all sites work locally to continuously improve the timeliness and quality of stroke care, the focus of the redesign is on access and flow as a region to improve efficiency and address any system-wide challenges.

Powell River telestroke

Sacha explains that throughout the discussions, leaders would consider Bob: “If he were fishing in Powell River – a community that has a very small number of stroke patients each year, but where it is difficult to transfer a patient to an urban centre fast enough – what would be best for him?”

That thought process led to the implementation of telestroke earlier this year.

“The emergency physician in Powell River can link to Vancouver General Hospital neurologists for consultation and guidance on patient treatment,” says Sacha. “We had our first successful telestroke case where tPA was given to the Powell River patient. Now we’re looking to expand the program to St. Mary’s Hospital and look at the possibility to offer telerehab to support smaller communities.”

Kimberley Leahy, a clinical nurse educator in Powell River, says that the staff involved felt very positive about the new process and the patient had a good health outcome. “The patient wanted to let everyone know she is doing well at home and is very thankful for the care she received,” says Kimberley.

Screening patients for depression

Richmond, St. Paul’s, Lions Gate and Vancouver General hospitals have also implemented depression screening because patients have a higher likelihood of developing depression after a stroke. It’s not just the emotional strain of having a stroke, there are physiological changes that occur in the brain that can lead to depression.

“It’s best practice to assess and intervene quickly so it doesn’t delay improvement,” says Sacha.

What’s next?

Overall there were 10 recommendations endorsed by the Senior Executive Team to improve access, flow and standardize care for patients. The detailed work and policy changes are still to come – for example, right now the team is working with BC Ambulance Services and the BC Patient Transfer Network to refine the transfer protocol (see the updated Life, Limb and Threatened Organ Transfer policy.) The North Shore team is also working with Community Engagement to ask patients and families about stroke care and whether they would want to be transported to VGH or stay at their local hospital.