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.

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 neighborhood 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 the base institution)

  • "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 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)