ABSTRACT
In 2001, the Ontario Ministry of Health and Long-Term Care introduced the Ontario Stroke Strategy by designating regional stroke centres across the province. The primary role of these centres is to coordinate stroke care within the region and across the care continuum in keeping with best practices. Concurrently, Trillium Health Centre was identifying best practice projects to support its ongoing quest for excellence. With Trillium designated as a regional stroke centre, acute ischemic stroke care was an obvious choice for a best practice project. The aim of the project was to improve access to care and quality of care for stroke patients from emergency through acute care to in-patient rehabilitation. The team chose the rapid cycle change methodology. This approach to quality improvement advocates the testing of a series of small changes (i.e., process improvement ideas) in tandem with measurements to assess the impact of the change to drive further process improvements. The project was deemed a success, resulting in significant improvements in the timeliness and quality of care.
Subject(s)
Benchmarking/organization & administration , Continuity of Patient Care/organization & administration , Regional Medical Programs/organization & administration , Stroke/therapy , Deglutition Disorders/diagnosis , Deglutition Disorders/etiology , Emergency Treatment/nursing , Emergency Treatment/standards , Focus Groups , Health Services Accessibility/standards , Hospitals, Community/organization & administration , Humans , Mass Screening/standards , Nursing Assessment/standards , Nursing Audit , Nursing Evaluation Research , Ontario , Organizational Objectives , Outcome and Process Assessment, Health Care/organization & administration , Program Evaluation , Risk Assessment/standards , Stroke/complications , Stroke/diagnosis , Time Factors , Tissue Plasminogen Activator/therapeutic use , Total Quality Management/organization & administration , Triage/standardsABSTRACT
Much work has been done in the past 10 years to research and document best practices in stroke care along the continuum of care. The challenge now for stroke care practitioners is to turn those best practices into reality in a clinical setting. In spite of a general understanding and acceptance of the benefits to the patient, an organization's culture and limited access to resources can frustrate our best efforts to introduce best practices at the bedside. Trillium Health Centre, a community hospital serving a diverse community of more than one million people, has turned best practice stroke care guidelines into reality by developing a 14-bed comprehensive stroke unit. This innovative approach to care uses specialized stroke teams, an interdisciplinary approach to care, and a single unit where the patient remains in the same bed throughout the acute and rehabilitation stages of care. Commitment to the new delivery model by formal leaders, informal leaders, and front-line staff and a supportive organizational structure contributed to an expedited and successful implementation. All changes were implemented without an increase in the overall resources assigned to the unit. Early results show that the average length of stay is shorter than the national standard and that provider and patient satisfaction have improved.
