Background
Methods
Definition and regional distribution of SUs
Statistical analyses
Results
LHIN | # of SU | Total population | # of stroke/TIA patients (2012-13)a
| # of stroke/TIA patients per SU |
---|---|---|---|---|
Erie St. Clair | 3 | 623,300 | 1,219 | 407 |
South West | 1 | 890,100 | 1,376 | 1,376 |
HNHB | 2 | 1,298,300 | 2,544 | 1,272 |
Waterloo Wellington | 1 | 679,700 | 996 | 996 |
Mississauga Halton | 1 | 1,002,300 | 1,480 | 1,480 |
Central West | 0 | 735,200 | 805 | N/A |
Central | 4 | 1,522,800 | 1,734 | 434 |
Central East | 4 | 1,419,800 | 2,052 | 513 |
Toronto Central | 4 | 1,075,100 | 2,464 | 616 |
North Simcoe Muskoka | 1 | 417,000 | 858 | 858 |
South East | 2 | 457,200 | 861 | 431 |
Champlain | 4 | 1,131,000 | 1,821 | 456 |
North East | 4 | 545,000 | 965 | 242 |
North West | 1 | 231,900 | 452 | 452 |
Ontario (total) | 32 | 12,028,900 | 19,327 | 604 |
Structure and organization
Acute SUs (n = 21) | Integrated SUs (n = 10) | Rehabilitation SU (n = 1) | Total SUs (n = 32) | |
---|---|---|---|---|
Operation time (mean ± sd, years)
| 6.9 ± 3.9 | 8.6 ± 5.2 | 3 ± 0 | 7.3 ± 4.4 |
<5 years (n, %)
| 7 (33) | 2 (20) | 1 (100) | 10 (31) |
≥5 years (n, %)
| 14 (67) | 8 (80) | 0 (0) | 22 (69) |
Geographic location (n, %)
| ||||
General medicine
| 14 (67) | 4 (40) | 0 (0) | 18 (56) |
Neurology
| 4 (19) | 0 (0) | 0 (0) | 4 (12) |
Rehabilitation
| 0 (0) | 4 (40) | 1 (100) | 5 (16) |
Dedicated unit
| 3 (14) | 2 (20) | 0 (0) | 5 (16) |
SUs with dedicateda beds (n, %)
| 10 (48) | 10 (100) | 1 (100) | 21 (66) |
Number of beds (median, range)
| 11 (4-37) | 19 (4-28) | 6 (-) | 13 (4-37) |
Mean bed occupancy percentage on a usual day (range)
| 80% (50-100) | 91% (60-100) | 83% (-) | 84% (50-100) |
Acute LOS (mean ± sd, days)
| 9.1 ± 4.2 | 8.2 ± 2.9 | - | 8.8 ± 3.7 |
Rehabilitation LOS (mean ± sd, days)
| - | 21.0 ± 10.9 | 38 ± 0 | 23.6 ± 10.7 |
Responsible physician for patient care | ||||
Stroke Neurologist (n, %)
| 6 (29) | 1 (10) | 0 (0) | 7 (22) |
General neurologist (n, %)
| 7 (33) | 1 (10) | 0 (0) | 8 (25) |
Internist (n, %)
| 13 (62) | 8 (80) | 0 (0) | 21 (66) |
Family physician (n, %)
| 3 (14) | 5 (50) | 1 (100) | 9 (28) |
SUs staff composition, workload and specialized training
Dedicated n (%) | Consultation n (%) | FTE per 10 beda median (range) | Patient to staff ratio | |
---|---|---|---|---|
Acute SUs (n = 21) | ||||
PT | 10 (47.6) | 11 (52.4) | 0.8 (0.6-2.7) | 12:1 |
OT | 10 (47.6) | 11 (52.4) | 0.8 (0.5-2.0) | 12:1 |
SLP | 6 (28.6) | 15 (71.4) | 0.6 (0.3-1.8) | 12:1 |
SW | 7 (33.3) | 14 (66.7) | 0.5 (0.3-1.0) | - |
Nutritionist | 5 (23.8) | 16 (76.1) | 0.2 (0.2-1.0) | - |
Pharmacist | 5 (23.8) | 16 (76.1) | 1.0 (1.0-2.0) | - |
Psychologist | - | 7 (33.3) | - | - |
RN | 6 (28.6) | 15 (71.4) | 11.3 (1.0-17.0) | |
Day-shift
| 4:1 | |||
Night-shift
| 6:1 | |||
RPN | 4 (19.1) | 13 (61.9) | 11.0 (2.9-12.5) | |
Day-shift
| 5:1 | |||
Night-shift
| 7:1 | |||
APN | 5 (23.8) | 3 (14.3) | 0.8 (0.3-1.0) | - |
Educator | 6 (28.6) | 15 (71.4) | 0.4 (0.2-1.7) | - |
Admin. staff | 5 (23.8) | 11 (52.4) | 0.6 (0.1-1.3) | - |
Care manager | 6 (28.6) | 12 (57.1) | 1.0 (0.4-2.5) | - |
Integrated SUs (n = 10) | ||||
PT | 6 (66.7) | 3 (33.3) | 0.8 (0.5-1.0) | 12:1 |
OT | 6 (66.7) | 3 (33.3) | 0.8 (0.5-1.0) | 13:1 |
SLP | 5 (55.6) | 4 (44.4) | 0.5 (0.3-0.6) | 14:1 |
SW | 5 (55.6) | 4 (44.4) | 0.5 (0.2-4.0) | - |
Nutritionist | 4 (44.4) | 5 (55.6) | 0.5 (0.2-0.6) | - |
Pharmacist | 3 (33.3) | 6 (66.7) | 0.8 (0.5-1.0) | - |
Psychologist | - | 3 (33.3) | - | - |
RN | 8 (88.9) | 1 (11.1) | 8.0 (3.5-13.0) | |
Day-shift
| 4:1 | |||
Night-shift
| 7:1 | |||
RPN | 7 (77.8) | 1 (11.1) | 4.2 (1.9-15.0) | |
Day-shift
| 5:1 | |||
Night-shift
| 7:1 | |||
APN | 2 (22.2) | 3 (33.3) | 0.3 (0.2-0.4) | - |
Educator | 2 (22.2) | 7 (77.8) | 0.9 (0.2-1.7) | - |
Admin. staff | 7 (77.8) | 1 (11.1) | 1.0 (0.4-1.8) | - |
Care manager | 6 (66.6) | 3 (33.3) | 0.4 (0.2-0.8) | - |
SUs patient population and processes of care
n (%)
| Acute SUs (n = 21) | Integrated SUs (n = 10) | Total (n = 32)a
|
---|---|---|---|
Available diagnostic procedures | |||
CT
| 21 (100.0) | 10 (100.0) | 31 (96.9) |
MRI
| 21 (100.0) | 9 (90.0) | 30 (93.8) |
Cerebral angiography
| 18 (85.7) | 8 (88.0) | 26 (83.8) |
Carotid Doppler ultrasound
| 20 (95.2) | 10 (100.0) | 30 (93.8) |
Available on-site surgical therapy | |||
Neuro/-vascular surgery
| 9 (42.9) | 3 (33.3) | 12 (37.5) |
Interventional neurology
| 10 (47.6) | 3 (33.3) | 13 (40.6) |
Interventional neuroradiology
| 12 (57.1) | 4 (44.4) | 16 (50.0) |
Standardized valid assessments scales | |||
Barthel index
| 8 (38.1) | 6 (60.0) | 14 (43.7) |
Canadian neurological scale
| 18 (85.7) | 7 (70.0) | 25 (78.1) |
NIHSS
| 14 (66.7) | 7 (70.0) | 21 (65.6) |
FIM
| 20 (95.2) | 10 (100.0) | 30 (93.8) |
TORBSST
| 10 (47.6) | 5 (50.0) | 15 (46.8) |
Braden scale
| 20 (95.2) | 10 (100.0) | 31 (96.8) |
Approaches to guide stroke care | |||
Written protocols
| 13 (65.0) | 8 (80.0) | 22 (70.9) |
Standardized order sets
| 21 (100.0) | 10 (100.0) | 32 (100.0) |
Monitoring of pressure area
| 21 (100.0) | 10 (100.0) | 32 (100.0) |
Interdisciplinary team meeting ≥1/week | 20 (95.2) | 10 (100.0) | 30 (93.8) |
Goal setting | 19 (90.5) | 9 (90.0) | 29 (90.6) |
Creation of individualized care plans | 12 (57.1) | 10 (100) | 23(71.8) |
Timing of initial discharge assessment | |||
< 24 h
| 7 (33.3) | 2 (20.0) | 9 (28.3) |
1-2 d
| 6 (28.6) | 5 (50.0) | 11 (34.4) |
3-4 d
| 5 (23.8) | 3(30.0) | 8 (25.0) |
< 4 d
| 3 (14.3) | 0 (0.0) | 3 (12.5) |
Core elements for SUs
| SU, n (%) |
---|---|
Geographically defined unit | 32 (100.0) |
Multidisciplinary team (physician, nurse, OT/PT/SLP/clinical nutritionist) | 32 (100.0) |
Advance training in stroke managementa
| 26 (81.3) |
Acute imaging (MRI/CT) | 32 (100.0) |
Valid scales (CNS/NIHSS/FIM) | 30 (93.8) |
Standardized order sets/protocols/algorithms | 32 (100.0) |
Interdisciplinary team meeting ≥1 per week | 31 (96.9) |
Creation of individualized rehabilitation care plans | 23 (71.8) |
Goal setting | 29 (90.6) |
Early discharge assessment (<48 h of admission) | 20 (62.5) |
Patient/carer education | 32 (100.0) |
In place rehabilitation (for Integrated SUs only) | 10 (100.0) |
All core elements met | 16 (50.0) |