Rural hospitals replicate experiences of big city stroke care

A new model for stroke care is being studied in rural Alberta to reduce inequities in health across communities. This model, presented at the Canadian Stroke Congress, shows how hospitals in rural areas can mimic the type of care that's often only available in larger centres.

In geographically diverse Canada, stroke care can seem like tale of two cities – or more like a city and a small town. The ideal is stroke unit care, where a multidisciplinary staff of doctors, nurses and therapists collaborate on treatment and the road to recovery. In Alberta, that type of care is only offered to 52 per cent of patients, mainly in urban settings. The proportion is lower in many other provinces. Frequently, hospitals in smaller centres just don't have the same resources.

"There are challenges in these smaller centres, mainly because of a lack of sub-specialists, dedicated beds or early exposure to therapists," says Dr. Thomas Jeerakathil, stroke neurologist and co-chair for the Stroke Action Plan project, which is funded by the Cardiovascular Health & Stroke Strategic Clinical Network, Alberta Health Services. "What we're trying to do is replicate the experience of stroke unit care for rural and smaller urban areas."

The study received the Canadian Stroke Congress Co-Chairs Award for Impact.

The model described in the study starts with SUEC, which stands for Stroke Unit Equivalent Care. "You train staff to have additional expertise in stroke, have standardized orders and pathways, which are protocols that are followed, and increase rehabilitation staffing," says Dr. Jeerakathil.

In the smaller hospitals, stroke patients should all consistently be admitted to the same ward. The idea is that over time staff there will develop greater proficiencies in responding to these patients.

Another key element in the Alberta model is early supported discharge (ESD). Currently, only 14 to 19 per cent of stroke patients receive intensive rehabilitation upon discharge. Dr. Jeerakathil suggests that ESD has the potential to expand intensive home-based rehab to another 30 per cent of stroke patients.

With ESD, stroke patients who don't need in-patient nursing, and who aren't medically fragile, go home from hospital sooner once plans are in place for caregiver and other support. That might include frequent visits from a physiotherapist or occupational therapist at home to meet the patient's rehabilitation needs. ESD is used in Edmonton and Calgary as well as in larger centres in other provinces such as Ontario, and is being expanded to small urban areas as part of the project.

The third service-delivery method integrated into the model is community rehabilitation (CR). Sometimes, patients living with the residual effects of a stroke may fare well for a time then decline. CR looks to catch people like that, with followup for medical attention and monitoring, and perhaps a refresher course in rehab.