Acute

General

Acute Stroke Care Orientation

Acute Stroke Unit Care Orientation (developed by Southwestern Ontario 2015): A Self-Directed Acute Stroke Unit Care Learning Program for Nurses and Allied Health Team

Stroke Distinction 

Accreditation Canada Stroke Distinction Program for Acute Stroke Services helps to provide a framework for the implementation of Stroke Best Practices. Kingston Health Sciences Centre has achieved Stroke Distinction in 2012, 2014 and 2018. 

To review latest KHSC Accreditation Canada Report, click here

AlphaFIM

AlphaFIM - Southeastern Ontario

For more information relating to AlphaFIM, please contact your Regional AlphaFIM(R) lead:

Shelley Huffman, BScPT
Regional Stroke Rehabilitation Coordinator
Stroke Network of Southeastern Ontario
613-549-6666 x6841
shelley.huffman@kingstonhsc.ca 

Assessment

Video: Bedside Neurological Assessment of the Stroke Patient

Dr. Al Jin, Medical Director for the Stroke Network of Southeastern Ontario explains and demonstrates how to quickly assess a stroke patient at the bedside.

National Institute of Health Stroke Scale (NIHSS)

The NIH Stroke Scale is a simple, reliable and valid clinical stroke assessment tool and document for nuerological status in acute stroke patients

Canadian Neurological Scale (CNS)

The CNS is a validated and recommended tool for assessing and monitoring the neurological status of stroke clients.  Please note that the Southeastern Ontario CNS Card must be ordered from lisa.ware@kingstonhsc.ca.

Dysphagia Screening, Monitoring & Management

Monitoring for Dysphagia Post Stroke Using the Screening Tool for Acute Neurological Dysphagia (STAND): Case Study Video

The following case studies demonstrate the importance of screening, monitoring and managing patients following a stroke for swallowing difficulties, known as dysphagia.

Module 1: Management of Dysphagia in Acute Stroke - Brockville General Hospital

In this online learning module you will learn the importance of screening stroke survivors for swallowing difficulties known as dysphagia and how to monitor and manage patients following a stroke for dysphagia.

Module 2: Dysphagia Screening Tool: STAND - Brockville General Hospital

In this online learning module you will learn how to perform a dysphagia screen using the "Screening Tool for Acute Neurological Dysphagia" also known as the STAND. At Brockville General Hospital, to complete this learning to be able to perform the STAND you will have to complete online learning modules 1 and 2 and then perform 1 return demonstration and 2 bedside patient demonstration with the SLP or a Dysphagia Screening Champion.

Risks of Swallowing Problems after Stroke:  ICES Research Video Series (Moira Kapral) 

About 50% patients who have recently had a stroke will experience dysphagia (swallowing problems) which can in turn lead to pneumonia, disability, and even death. That's why guidelines recommend that swallowing tests be conducted in all stroke patients within the first 72 hours after stroke, before taking any food or liquid by mouth.
It was found that 1 in 5 stroke patients were not given swallowing tests, particularly if the stroke was mild, even though all patients who experience stroke (whether severe or mild) are at risk of swallowing problems. They say that all care providers need to be aware of the importance of swallowing tests, since failed tests or missed diagnoses put patients at very high risk of disability, pneumonia and death.

Stroke Units

Acute Stroke Unit

All patients admitted with stroke or TIA should spend time on a specialized geographically defined hospital unit (identifiable co-located beds). In this unit patients  receive care from a dedicated interprofessional team with expertise in stroke care including at a minimum medicine, nursing, physiotherapy, occupational therapy, and speech language therapy. This dedicated team spends the  vast majority of their time caring for stroke patients and complete stroke care education on a regular basis. Patients who spend time on an Acute Stroke Unit are more likely to survive and recover after their stroke.  To optimize outcomes and efficiencies, stroke volumes should be at least 125 stroke patients per year per hospital. See references for more information:

 

Acute Stroke Unit Care

Acute Stroke Unit Care in Kingston, Frontenac, and Lennox & Addington Counties

All patients from Kingston, Frontenac, and Lennox & Addington Counties have the opportunity to benefit form clustered stroke unit care at the Kingston Health Sciences Centre-Kingston General Hospital Site. Consolidation of stroke unit care with Lennox & Addington County General Hospital and Kingston Health Sciences Centre took place in September 2014. 

  • Click here for Algorithm for Stroke Care-L&ACGH/KHSC-KGH Site

Integrated Stroke Unit Care

An Integrated Stroke Unit has acute and rehabilitation care components with both acute and rehabilitation beds on a co-located geographical unit and has a dedicated interprofessional team with expertise in stroke care including at a minimum, nursing, physiotherapy, occuaptional therapy and speech language therapy. Rehabilitation is an important element of integrated stroke care. Patients spending time on an Integrated Stroke Unit have been noted in the literature to have shorter times to discharge home. To optimize outcomes and efficiencies, stroke volumes should be at least 100 stroke patients per year per hospital. 

Quinte Health Care Integrated Stroke Unit

Quinte Health Care (QHC) Integrated Stroke Unit was launched in December 11, 2018.  Expert clinical teams providing acute care and rehabilitation at QHC came together to form one geographically cohesive environment for stroke care within the larger Rehabilitation Unit on Sills 3 at the Belleville General Hospital Site. Preleminary evaluation findings indicate trend in lower mortality rate and improvement in rehabiliation service intensity.  

Click here for presentation about the QHC Integrated Stroke Unit including other quality improvement initiatives delivered to the Regional Stroke Steering Committee on December 12, 2019.

Brockville General Hospital Integrated Stroke Unit

The new Integrated Stroke Unit (ISU) at Brockville was successfully launched on October 12, 2022. The new ISU at Brockville General Hospital (BrGH) builds upon the previous work to establish an Acute Stroke Unit at Brockville General Hospital (BrGH) in 2013 and its expansion to serve all of Lanark, Leeds, Grenville (LLG) counties in 2016 through the partnership of Perth and Smiths Falls District Hospital and BrGH.  The ISU is located on the 2nd floor of the new Donald B. Green Tower. 

Stroke Unit Care is known to improve survival rates and to optimize recovery and return home. The new ISU at BrGH is dedicated to the care of stroke patients in the LLG counties and provides both acute and rehabilitation care following a stroke. Preliminary evaluation indicates higher stroke unit utilization and other key stroke best practices are in place.

Click here for Algorithm for Lanark, Leeds & Grenville Stroke Unit Care

Click here for a video to see Linda and Joan (stroke survivors) and their families describe the importance of acute stroke unit care. 

Click here to view the Welcome ISU booklet

A Toolkit for Implementation of Stroke Unit Care

This provincial resource supports the Canadian Best Practice Recommendations for Stroke Care in the acute care and inpatient rehabilitation settings. It provides guidance for the establishment of new stroke units and the enhancement of exising stroke untis to provide optimal services and processess of care for stroke patients. 

Physician Guide for Stroke Transfers

The Physician Guide for Regional Stroke Transfers to KHSC-KGH Site includes a mapping guide for for those that meet or do not meet the Acute Stroke Protocol criteria. Brief guidance about hemorrhagic stroke is also included. This guide is intended for Residents and new physicians at KHSC. 

  • Click here for the physician guide