Experience in Other Provinces: Nova Scotia Stroke System Neala Gill, RN, BN, MA Cardiovascular...
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Transcript of Experience in Other Provinces: Nova Scotia Stroke System Neala Gill, RN, BN, MA Cardiovascular...
![Page 1: Experience in Other Provinces: Nova Scotia Stroke System Neala Gill, RN, BN, MA Cardiovascular Health Nova Scotia Quebec Summit on Stroke October 7, 2008.](https://reader035.fdocuments.in/reader035/viewer/2022062422/56649ec75503460f94bd409e/html5/thumbnails/1.jpg)
Experience in Other Provinces:Nova Scotia Stroke System
Neala Gill, RN, BN, MACardiovascular Health Nova Scotia
Quebec Summit on StrokeOctober 7, 2008
![Page 2: Experience in Other Provinces: Nova Scotia Stroke System Neala Gill, RN, BN, MA Cardiovascular Health Nova Scotia Quebec Summit on Stroke October 7, 2008.](https://reader035.fdocuments.in/reader035/viewer/2022062422/56649ec75503460f94bd409e/html5/thumbnails/2.jpg)
Presentation Overview
• Background Information
• Factors Influencing Direction & Decision Making
• Funding Formula & Enhancements
• Enablers
![Page 3: Experience in Other Provinces: Nova Scotia Stroke System Neala Gill, RN, BN, MA Cardiovascular Health Nova Scotia Quebec Summit on Stroke October 7, 2008.](https://reader035.fdocuments.in/reader035/viewer/2022062422/56649ec75503460f94bd409e/html5/thumbnails/3.jpg)
Nova Scotia
• Population just under 1 million
• Services provided through 9 District Health Authorities with populations varying from 33,000 to 398,000
• Highest in-hospital stroke mortality in Canada, as reported by CIHI
![Page 4: Experience in Other Provinces: Nova Scotia Stroke System Neala Gill, RN, BN, MA Cardiovascular Health Nova Scotia Quebec Summit on Stroke October 7, 2008.](https://reader035.fdocuments.in/reader035/viewer/2022062422/56649ec75503460f94bd409e/html5/thumbnails/4.jpg)
Cardiovascular HealthNova Scotia
• Program of NS Department of Health• Provincial mandate – stroke and cardiac disease• Like other provincial programs, created to
– Improve care throughout NS– Develop/recommend care standards and service delivery
models, including funding recommendations– Assist District Health Authorities in implementation of
standards and service delivery models– Provide/coordinate related continuing education– Monitor & report outcomes
• Provincial quality improvement program
![Page 5: Experience in Other Provinces: Nova Scotia Stroke System Neala Gill, RN, BN, MA Cardiovascular Health Nova Scotia Quebec Summit on Stroke October 7, 2008.](https://reader035.fdocuments.in/reader035/viewer/2022062422/56649ec75503460f94bd409e/html5/thumbnails/5.jpg)
History in Brief
• Re-Organizing Stroke Care In NS - 2002• Gap Analysis - 2003• Stroke Services Inventory Report - 2004• SWH Stroke Demonstration Project - 2005-2007• Funding commitment – 2006• Provincial Stroke Audit - 2007• Professional Education Partnership - 2008• NS Stroke Care Guidelines – 2008
![Page 6: Experience in Other Provinces: Nova Scotia Stroke System Neala Gill, RN, BN, MA Cardiovascular Health Nova Scotia Quebec Summit on Stroke October 7, 2008.](https://reader035.fdocuments.in/reader035/viewer/2022062422/56649ec75503460f94bd409e/html5/thumbnails/6.jpg)
Factors Influencing Direction
• Stroke strategy document recommendations
• Best practice guidelines
• Findings of audit of all admissions for stroke in 1 fiscal year – RCSN
• Evidence of changes that would provide the biggest potential impact (Cochrane reviews)
• Available funding (announcement preceded planning)
![Page 7: Experience in Other Provinces: Nova Scotia Stroke System Neala Gill, RN, BN, MA Cardiovascular Health Nova Scotia Quebec Summit on Stroke October 7, 2008.](https://reader035.fdocuments.in/reader035/viewer/2022062422/56649ec75503460f94bd409e/html5/thumbnails/7.jpg)
Nova Scotia Stroke Audit:What Did We Find?
• 66% of hospitals care for < 34 patients / year
• Significant differences in case-mix, treatment, and outcomes, both between and within Districts
• Some districts do not have critical mass
• Diagnosis and other medical details poorly documented
![Page 8: Experience in Other Provinces: Nova Scotia Stroke System Neala Gill, RN, BN, MA Cardiovascular Health Nova Scotia Quebec Summit on Stroke October 7, 2008.](https://reader035.fdocuments.in/reader035/viewer/2022062422/56649ec75503460f94bd409e/html5/thumbnails/8.jpg)
Nova Scotia Stroke Audit:What Did We Find?
• Care falls far short of Canadian Best Practice Recommendations
• Stroke-unit care non-existent
• Thrombolysis rates low
• Wide variation in:– use of brain imaging & other medical tests– use of medications to prevent stroke recurrence
– access to rehabilitation treatment
![Page 9: Experience in Other Provinces: Nova Scotia Stroke System Neala Gill, RN, BN, MA Cardiovascular Health Nova Scotia Quebec Summit on Stroke October 7, 2008.](https://reader035.fdocuments.in/reader035/viewer/2022062422/56649ec75503460f94bd409e/html5/thumbnails/9.jpg)
Potential Effectiveness of Stroke Treatments inNova Scotia
Intervention * Benefit per 1000 treated
¶ Target pop. § N (%) avoided/yr
Stroke unit 56 1,600 (80%) 90 (8%)
Aspirin 12 1,900 (95%) 22 (2%)
t-PA 63 200 (10%) 13 (1%)*avoidance of death or dependency from Cochrane reviews¶ assuming 2,000 strokes per year in Nova Scotia§ assuming 55% patients dead/dependent at 1 yr untreated
![Page 10: Experience in Other Provinces: Nova Scotia Stroke System Neala Gill, RN, BN, MA Cardiovascular Health Nova Scotia Quebec Summit on Stroke October 7, 2008.](https://reader035.fdocuments.in/reader035/viewer/2022062422/56649ec75503460f94bd409e/html5/thumbnails/10.jpg)
Current TeamInvolvementTeam Member/Assessment QEII Others in
NSDietitian 57% 34%
Dysphagia 40% 24%
Nurse Practitioner 92% 0%
Occupational Therapy 69% 33%
Physiotherapy 69% 50%
Speech Language Pathologist 29% 16%
Social Worker 42% 26%
![Page 11: Experience in Other Provinces: Nova Scotia Stroke System Neala Gill, RN, BN, MA Cardiovascular Health Nova Scotia Quebec Summit on Stroke October 7, 2008.](https://reader035.fdocuments.in/reader035/viewer/2022062422/56649ec75503460f94bd409e/html5/thumbnails/11.jpg)
Decisions
• Investing in enhanced interdisciplinary stroke teams and clustering patients would likely have the greatest benefit
• Government commitment of $3 million is sufficient for– staffing enhancements to improve the acute &
rehabilitation care processes– Leadership/transition coordination– Secondary prevention – Specialty Nurse Practitioner
![Page 12: Experience in Other Provinces: Nova Scotia Stroke System Neala Gill, RN, BN, MA Cardiovascular Health Nova Scotia Quebec Summit on Stroke October 7, 2008.](https://reader035.fdocuments.in/reader035/viewer/2022062422/56649ec75503460f94bd409e/html5/thumbnails/12.jpg)
Decisions
• Partnerships in initiatives being developed under additional funding envelopes would be necessary to improve care across the continuum– restorative care initiatives– chronic disease management
• Focus is on enhancing existing capacity and reorganizing existing services
• Location of services based on critical mass to maintain high quality care– Adverse outcomes more frequent in facilities with < 100 strokes/year– 115 strokes/year = 6 bed stroke unit– Shared services required across some Districts
![Page 13: Experience in Other Provinces: Nova Scotia Stroke System Neala Gill, RN, BN, MA Cardiovascular Health Nova Scotia Quebec Summit on Stroke October 7, 2008.](https://reader035.fdocuments.in/reader035/viewer/2022062422/56649ec75503460f94bd409e/html5/thumbnails/13.jpg)
Process
• Reviewed and used evidence to develop formula for equitable funding across districts– Estimated current capacity from stroke audit– Set targets for percentage of patients to be seen by each
team member• Held consultation meetings – each District Health
Authorities, other stakeholders• Requested proposals from all District Health
Authorities– Local planning - representatives from across continuum &
multiple sites– Based on the plan and funding formula
![Page 14: Experience in Other Provinces: Nova Scotia Stroke System Neala Gill, RN, BN, MA Cardiovascular Health Nova Scotia Quebec Summit on Stroke October 7, 2008.](https://reader035.fdocuments.in/reader035/viewer/2022062422/56649ec75503460f94bd409e/html5/thumbnails/14.jpg)
Estimated # Beds
DHA # Stroke Admissions/Year, NS Stroke Audit
(2005/06)
Estimated # Stroke Beds/DHA
1 80 4 2 121 6 3 152 8 4 95 5 5 46 2 6 76 4 7 52 3 8 245 13 9 520 30
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Staffing Requirements
Discipline
FTE per 7 Bed Unit
FTE per 8 Bed Unit
FTE per 13 Bed Unit
Specialty Nurse Practitioner
0.7 0.8 1.3
Nursing 9.8 11.2 18.2 Occupational Therapy
0.7 0.8 1.3
Physiotherapy 0.7 0.8 1.3 Social Work 0.35 0.4 0.65 Dietitian 0.6 0.7 1.0 Speech-Language Pathology
0.7 0.8 1.3
![Page 16: Experience in Other Provinces: Nova Scotia Stroke System Neala Gill, RN, BN, MA Cardiovascular Health Nova Scotia Quebec Summit on Stroke October 7, 2008.](https://reader035.fdocuments.in/reader035/viewer/2022062422/56649ec75503460f94bd409e/html5/thumbnails/16.jpg)
7 Centres
![Page 17: Experience in Other Provinces: Nova Scotia Stroke System Neala Gill, RN, BN, MA Cardiovascular Health Nova Scotia Quebec Summit on Stroke October 7, 2008.](https://reader035.fdocuments.in/reader035/viewer/2022062422/56649ec75503460f94bd409e/html5/thumbnails/17.jpg)
Additional Work
• Dissemination & implementation of Nova Scotia Stroke Care Guidelines
• Explore primary prevention & other partnerships• Facilitate forums for sharing of successes,
approaches and tools across Districts• Provide continuing education based on guidelines• Develop framework for monitoring & surveillance• Explore potential for use of Telestroke
![Page 18: Experience in Other Provinces: Nova Scotia Stroke System Neala Gill, RN, BN, MA Cardiovascular Health Nova Scotia Quebec Summit on Stroke October 7, 2008.](https://reader035.fdocuments.in/reader035/viewer/2022062422/56649ec75503460f94bd409e/html5/thumbnails/18.jpg)
Enablers• Data to show districts how they are currently doing
compared to best practice• Nova Scotia Stroke Care Guidelines• Broad stakeholder engagement• Demonstration project in 1 District• Department of Health program with a mandate to
facilitate & monitor improvements in stroke care• Sharing of resources and tools throughout province• Opportunities to share experiences• Local coordination and transition planning