Stroke Unit

Your stroke rotation is a team environment where one engages with many colleagues across medical specialties, allied health teams, and nursing. The stroke Unit brings together neurology & in-patient medical care in a unique way.

Please review the mini-PodCast episodes below for a series of brief overviews on various aspects of your Stroke Rotation.

Daily we meet with our allied health colleagues on The Stroke Unit, for "Bullet Rounds" at 9:45AM.

The focus of Allied Health "bullet rounds" is the following:

    • Discuss disposition issues for each stroke in-patient

    • Discuss outstanding tests, plans, consults, that are holding up discharge planning/disposition

    • Discuss the patient's disposition trajectory: home, home with out-patient rehab, or inter-facility transfer with in-patient rehab

      • for any kind of rehab an "E-Stroke" form needs to completed by the MD and each Allied Health; ask your friendly neighbourhood allied health team member to show you this resource; our Allied Health Team can log you in to complete the MD portion.

    • Discuss transfers in / out of the stroke unit; for example tPA and EVT patients who are in the ICU, and readiness for transition out of the stroke unit.

STROKE ROTATION ORIENTATION

Stroke SHSC Orientation 2018.pptx.pptx

Clinical Pearls:

  • Please Checkout Pharmacy Services for additional Important Information from Our Pharmacy Team, regarding the general care of stroke patients and How-To perform Medication Transfer Reconciliation on admitted or transferred patients!

  • See ward patient under the stroke service first before the day gets busy

  • Phone-in consults to other services early in the day

  • On admission use Templates/Work-flows to help standardize the admission process and pending investigations; allow your admission note to transition seamlessly to a progress note, and ultimately a discharge note

  • Keep the sign-out list updated

  • Provide daily handover to Orange Team and Receive daily handover

  • Key points to consider to made for a great stroke rotation

    • excellence in patient care

    • efficient and concise handover

    • disposition and discharge planning


  • See the in-patients first (i.e. patients admitted under the stroke service on B4 or bed-spaced to other wards)

  • Designate MD Roles in the Morning - MD1, MD2

  • Daily check of Medication Reconsiliation on Sunnycare

  • Provide handover: On-call Neuro resident, Orange Team resident/fellow, also Receive Handover

    • Sr/designate to handover to Orange Team Daily

    • Sr/designate to receive Handover from Orange Team Daily

  • Update the Sign-out List daily

Flow of Stroke Patients (during the acute Code Stroke) phase:

Flow diagram of patients during a Code Stroke activation. This is meant as a general guide/outline of our current processes. Please note that each individual case needs consideration.

Clinical Pearls:

  • First questions to ask during code stroke

    • Last seen well?

    • Did you bypass a hospital? (repatriation implication)

    • acute medical history, clinical course on scene, glucose, BP; any deterioration on transport

    • TPA contraindications - antiplatelets, anticoagulants, recent surgery, recent trauma, recent stroke/TIA, malignancy, etc...

  • If the patient looks unstable ask for help early - ED/Emerg MD or Critical Care consult - ED first to stabilize the patient/airway management

Repatriation Brochure.pdf

Stroke patients are admitted to the hospital from the following routes:

  • Direct presentation to ED (i.e. hospital catchment - pt walks in/EMS brings patient to SHSC)

  • "Walk-in Protocol" - our hospital partners will send strokes directly from their ED to our hospital for assessment - these are then activated as a code stroke on arrival - referring hospitals include:

    • North York General Hospital

    • Scarborough Hospitals (Birchmount, General)

    • If these patients are not treated with TPA/EVT, and/or if they need admission to hospital, they are repatriated from the ED to their home hospital.

  • via CritiCall

    • from MacKenzie Hospital - a TPA centre, we have a Drip-and-Ship model, where TPA is given at MacKenzie and patients (who are candidates meeting specific criteria) come to hospital for (consideration/treatment) EVT

    • CritiCall life-or-limb protocol for EVT from other hospitals

  • Transfer from ICU to the Stroke Unit - post-TPA or TPA/EVT after 24H of observation if there are not active medical issues.

Stroke patients are discharged from our C4 Stroke unit to the following disposition possibilities:

  • Home (with CCAC, Private Support, Family)/Home with out-patient rehabilitation

  • In-patient rehabilitation

  • Repatriation to home/bypassed hospitals

  • Other health facility: PCU, Long-term Care (LTC)

Stroke Rotation - Introductory Podcasts

The following are a series of short audio podcasts with some introductory information regarding your stroke rotation and how things generally work. The final topic "Summary and Key points" ends the segments and contains some general guidelines regarding workflow.