Dr. Leanne Casaubon
Dr. Leanne Casaubon, a neurologist at the Krembil Neuroscience Centre, tells UHN News how Stroke Distinction will help improve patient experience and team engagement at Toronto Western Hospital. (Photo: UHN)

Toronto Western Hospital already has a reputation for clinical excellence and leadership in the delivery of acute stroke care.

So it should come as no surprise that the team responsible for building that reputation is seeking a special accolade for organizations that go above and beyond what is expected in the delivery of stroke care.

It's called Stroke Distinction and it is granted to hospitals that demonstrate a commitment to innovation, high-quality service and positive outcomes for stoke patients.

The process of securing Stroke Distinction takes place over several months and requires staff to submit a comprehensive set of quality indicators, demonstrate an adherence to a list of best practices, and welcome an on-site survey team from Accreditation Canada.

Dr. Leanne Casaubon, a neurologist at the Krembil Neuroscience Centre (KNC) and physician lead for the Stroke Distinction endeavor at Toronto Western, discussed with UHN News the importance of this initiative.

Q: What is Stroke Distinction and why is it important?

A: Stroke Distinction is an evaluation program through Accreditation Canada.  There are few clinical programs that have an organized system in place that are evaluated through the Distinction program. A lot of work has been done in Canada to develop stroke best practice recommendations and a system of evaluation, monitoring and organization of stroke care. Through Accreditation Canada, hospital programs are recognized with Stroke Distinction if they meet the recommended standards, as determined through an on-site survey conducted by experts from across the country and through meeting best-practice targets for key quality data indicators.

Q: So what is the difference between Accreditation and Distinction?

A: We are one of a growing number of stroke centres that is going forward with this formal evaluation through Stroke Distinction that would go beyond the hospital Accreditation already attained by UHN. Distinction will give us an acknowledgment on a national level that we are meeting all of the best practice standards and are aligned with the other top institutions in Canada for stroke care.

Q: What does it mean to be a stroke centre?

A: For us it means infusing best practice care into everything we do at Toronto Western and providing optimal care to patients who come to us with either a stroke or some other neurovascular problem.

Q: How did you become such an integral part of the stroke network in Ontario?

A: Our site is one of the original leading sites that worked to develop the stroke system. It was colleagues of ours, including Dr. Frank Silver (medical director of the UHN Stroke Program), who worked to develop the stroke system framework. That hard work allowed us to become one of the organizational leaders for stroke care in the province and the country.

Q: How have outcomes for stroke patients changed as a result of changes to the stroke network in Ontario?

A: There is data showing reductions in mortality from stroke and improvements in functional recovery since the organized Ontario Stroke System was formalized. For many years, stroke was thought of as somewhat hopeless, with few opportunities for treatment and recovery, but that's completely changed. Now, there are many acute treatments, rehabilitation programs, and stroke prevention strategies that are allowing persons with stroke to have better outcomes.

Q: How many patients does the stroke team see in an average year?

A: At our site, we have various groups of patients that we see. We provide acute care through the emergency department, in-patient care on our Neurovascular Unit (our stroke unit), rapid-access ambulatory care in the TIA (Transient Ischemic Attack) and Minor Stroke Unit, and prevention services through our Stroke Prevention Clinic. So when you look at the overall population, we see more than 1,000 patients a year.

Q: How will achieving Stroke Distinction improve the quality of care for your patients?

A: At UHN we have already made several process improvements through the Lean quality improvement program. We wondered how we could further improve our care practices and we discovered that Stroke Distinction would take us to the next level for meeting the nationally recommended guidelines for excellence in stroke care.

Q: Who are some of the people or groups involved in Stroke Distinction?

A: We were very comprehensive about including anyone who has any potential involvement with patients with stroke or other neurovascular disorders. We reached out to our community partners, including paramedics, we included our partners in the emergency department, medical imaging department, intensive care unit team, Neurovascular Unit team (including stroke neurology and vascular neurosurgery teams and unit staff), and patient education so that we ensure that anywhere the patient could be, we've engaged that team. We also have patient partners working closely with our teams in this endeavor.

Q: What is the timeframe for Stroke Distinction and how do you maintain it?

A: It takes 12-14 months with a lot of the work on the ground ensuring the stroke best practices are infused into the work we do. The data is another key piece because it documents our performance measures.  It has been just over a year's journey so far and we are very much looking forward to celebrating after our survey, which takes place April 25 to 27, 2017. After achieving Stroke Distinction, we will have a sustainability plan with ongoing quality improvement work and data submission to Accreditation Canada every six months to demonstrate continued excellence in stroke care. Every four years, a hospital program must apply for re-accreditation through the Stroke Distinction program.

Q: What can you tell us about the survey?

A: Accreditation Canada will assign two expert surveyors who are well-versed in both hospital accreditation and the stroke best practice recommendations. They are not necessarily stroke experts, but they have expertise in quality care. They will spend two days with us. They will immerse themselves in what we do. It will be intensive in terms of their approach. They will basically travel to all the areas a stroke patient may be while in our care. They might have specific pointed questions that relate to the best practice standards and they will review all of our care processes. And they will be making sure our team is able to articulate best practices for stroke care.

Q: Is there a physical test that needs to be completed?

A: In addition to the on-site survey, we have significant amounts of data and a detailed report that we prepare in order to highlight the quality improvement work that we've already done. That takes place before the survey, which allows the surveyors to take a deeper dive when they arrive. There is a significant amount of work for our team over the course of next few months to bring everything together in order to highlight all the great work we've done in the last year toward Stroke Distinction.

Q: When will we know if you've achieved Stroke Distinction?

A: When the surveyors are here they will provide some feedback, but we will not have a final ruling from Accreditation Canada until a short time after that. The report will tell us where we did very well and highlight any areas where we may need to do a little bit of work. After that we will learn if we have met all the standards for Stroke Distinction.

Q: Assuming you achieve it, how long does the Distinction last for?

A: Hopefully this summer we will celebrate our success. However, at the same time we need to continue to work on our sustainability plan so we maintain all the work that's been done so far.  The work does not stop after we receive Stroke Distinction. Every four years, stroke centres need to be re-accredited.

Q: Where do you see the field of stroke care going in the future?

A: Without having a crystal ball, I do believe we will continue to enhance the organization of stroke care services in Ontario. I think we will find new and additional ways to improve the lives of patients who have a stroke or neurovascular disorder. There is a big push now to go beyond a stroke patient's journey in acute care, to focus further on rehabilitation and recovery. We also need to look at stroke prevention and how we can help other groups in the community to develop stroke and neurovascular-related expertise.​

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