People with stroke-like symptoms – who have been assessed and referred to Regina Qu’Appelle Health Region’s Stroke Prevention Clinic for preventative follow up – are now seen by the clinic within an average of three to four days post-referral, rather than the previous six to eight.
“We’re providing timely care in a more efficient way that’s convenient to the patient. Early action can prevent future strokes. It can save mobility, or save a life.”
(Dr. Zia Rehman, neurologist, Stroke Prevention Clinic)
How did this improvement occur?
“We knew we had to make some major changes,” said Cheryl Loucks, a registered nurse and clinic coordinator. Demand for services has been growing, she said. In the past two years, new referrals have increased 56%, from 591 in 2013-14 to 924 in 2015-16. As a result, not all clinic patients were seen by a neurologist within the accepted evidence-based guidelines.
“We know from recent evidence that 10% of patients who have a stroke-like event are at risk of having a stroke within one week,” said Tom Stewart, clinic manager. “Getting them seen in a timely manner can mean the difference between life and death.”
Stroke-like symptoms are caused by a transient ischemic attack (TIA) – a brief interruption of blood flow to part of the brain, spinal cord or retina. They include facial drooping, weakness on one side of the body, slurred or loss of speech, extremely painful headaches, trouble walking, talking or understanding things and vision loss in one or both eyes. A TIA does not damage brain cells or cause permanent disability.
A stroke occurs when the blood supply to part of the brain is interrupted or severely reduced. During a stroke, brain cells die at a rate of approximately 1.9 million per minute.
The team began introducing changes through a rapid process improvement project (RPIW 84) in the fall of 2015 which reduced patient waiting, improved clinic flow, led to better skill-task alignment among staff, and implemented patient education and appointment follow-up processes.
Fundamental to improving clinic access was a move in January to the fifth floor of the Regina General Hospital (RGH). This relocation brought the office staff and the clinic together in one space. Previously, the clinic, which was held Mondays (full day) and Thursdays (half day only), saw patients in space borrowed from Ambulatory Care, on the hospital’s second floor. The office staff, meanwhile, were situated on the fifth floor, preventing them from assisting with clinics.
Administrative duties have now been realigned so that Loucks can spend more time on clinic work. Patient information is at hand; the addition of one exam room, bringing the total number to three, means patients can stay in their exam room for their full visit; and administrative staff are available to help with clinics. The fifth-floor location is a short walk from the Neurosciences Unit, which is convenient when clinic patients need to be admitted.
Clinic service has changed to Monday, Wednesday and Friday mornings. Because the team is in its own space, clinic hours can be extended when necessary.
“Having more frequent clinic days and as much time as we need to see patients allows us to see the more urgent patients in a timely way. This is better for the patient and takes some of the load off of Emergency.”
(Tom Stewart, manager, Stroke Prevention Clinic)
All patients are triaged and scored for stroke risk with only the most urgent patients being directed to Emergency, noted Stewart.
The team has reserved CT, ultrasound and cardio-neuro diagnostic testing times, which allow for same-day testing and result in quicker diagnosis. Patients who previously needed to be admitted to, or remain in hospital, can receive a range of diagnostics through the clinic.
Follow-up appointments are now booked before patients leave the clinic to ensure continuity of care.
Stewart and Loucks said many people need to be thanked for their role in the clinic changes. They include neurologists Dr. V. Pillay, Dr. A. Raghig, Dr. M.S. Ijaz and Rehman; cardiologist Dr. H. Gargoum; educator RN June Richter; 5A manager Jodi Foley; all staff of the Stroke Prevention Clinic for continuing to provide exemplary service during a clinic move and redesign; RQHR’s senior leadership; Facilities Management; the College of Medicine for trading spaces; and the RPIW 84 team.
Photo: Pictured are members of the Stroke Prevention Clinic team (L-R): Cheryl Loucks, registered nurse/clinic coordinator; Tom Stewart, clinic manager; Dr. Zia Rehman, neurologist; Leah Evans, registered nurse; June Richter, educator; and Kim Gilbert, office administrative assistant. Photo credit: Medical Media Services.