The characteristics of stroke units in Ontario: a pan-provincial survey

Abstract

BackgroundPrevious studies have demonstrated that organized, multidisciplinary care is the cornerstone of current strategies to reduce the death and disability caused by stroke. Identification of stroke units and an understanding of their composition and operation would provide insight for the further actions required to improve stroke care. The objective of this study was to identify and survey stroke units in Canada’s largest province, Ontario (population of 13 million) in order to describe availability, structure, staffing, processes of care, and type of population stroke units serve.MethodsThe Ontario Stroke Network (2011) list of stroke units and snowball sampling was used to identify all stroke units. During 2013 – 2014 an interviewer conducted telephone surveys with the stroke unit managers using closed and semi-open ended questions. Descriptive statistics were used to summarize survey responses.ResultsThe survey identified 32 stroke units, and a respondent from every stroke unit (100% response rate) was interviewed. Twenty one were acute stroke units, 10 were integrated stroke units and one was classified as a rehabilitation stroke unit. Stroke units were available in all 14 Local Health Integration Networks except Central West. The estimated average number of stroke patients served per stroke unit was 604 with six-fold variation (242 to 1480) across the province. The typical population served in stroke units were patients with either ischemic or hemorrhagic stroke. Data consistently reported on the processes of stroke care, including the availability of multidisciplinary staff, specific diagnostic imaging, use of validated assessment tools, and the delivery of patient education. Details about the core components of stoke care were provided by 16 stroke units (50%).ConclusionsThis study demonstrates the heterogeneous structure of stroke units in Ontario and signaled potential disparity in access to stroke units. Many core components are in place, but half of the stroke units in Ontario do not meet all criteria. Areas for potential improvement include stroke care training for the multidisciplinary team, provision of individualized rehabilitation plans, and early discharge assessment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2099-1) contains supplementary material, which is available to authorized users.

The use of the environmental scan in health services delivery research: a scoping review protocol

“…Although environmental scans have been widely adopted in the healthcare sector to inform decision-making,12 31 37–59 there is no consensus on a definition to guide research and practice. This paper presents a protocol for a scoping review that will map the extent, range and nature of evidence examining the use or application of environmental scans within the health services delivery context.…”

“…Environmental scans have been used as an effective approach to information gathering for a range of specific purposes (table 1). These include reviewing the current state of services and programmes, evaluating community and patient needs, identifying service gaps, assessing professional education and training needs, supporting quality improvement initiatives, and informing programme and policy development 12 31 37–59. For instance, environmental scans have been used to assess remote symptom support training programmes for nurses in ambulatory oncology programmes56 and to describe paediatric navigation models across Canada 39…”

“…Despite the wide adoption of environmental scans within the healthcare sector,12 31 37–59 there is no consensus on a working definition or conceptual framework specific to health services delivery, and methodological guidance on the design and implementation of this approach to guide research and practice is lacking in the literature 12 29–31 45. Various terminologies have been used to describe the concept.…”

Canadian Stroke Best Practice Recommendations: Acute Stroke Management, 7th Edition Practice Guidelines Update, 2022

“…A survey conducted in 2013/14, identified 32 stroke units within the province of Ontario, of which 21 were acute stroke units, 10 were integrated stroke units and one https://doi.org/10.1017/cjn.2022.344 Published online by Cambridge University Press which was classified as a rehabilitation stroke unit. 64 The estimated average number of stroke 396 patients served per stroke unit was 604 with large variation across centres. 397 Note: Stroke unit care is the gold standard for care following acute stroke.…”

“…A survey conducted in 2013/14 identified 32 stroke units within the province of Ontario, of which 21 were acute stroke units, 10 were integrated stroke units, and 1 which was classified as a rehabilitation stroke unit. 64 The estimated average number of stroke patients served per stroke unit was 604 with large variation across centers. i.…”