Acute care is where the person is stabilized, diagnosis confirmed, plans are implemented to prevent complications, and when initial rehabilitation and recovery begin.
Hyperacute stroke care is time sensitive and involves assessment, stabilization and treatment in the first hours after stroke or TIA onset. It represents all pre-hospital and initial emergency care for TIA and stroke. This includes thrombolysis or endovascular interventions for acute ischemic stroke, emergency neurosurgical procedures, and same-day TIA diagnostic and risk stratification evaluation.
The primary underpinnings of ‘hyperacute stroke care’ are to RECOGNIZE and MOBILIZE. This starts with recognition of stroke symptoms by patients, families and bystanders. The Heart and Stroke Foundation has launched a new signs of stroke campaign in 2014 that uses the FAST mnemonic (FACE, ARM, SPEECH, TIME) aiming to increase recognition of the signs of stroke and take appropriate action immediately. Mobilization has to occur without delay, from emergency medical services response to a potential new stroke patient, transport to hospitals with specialized stroke services, rapid access to neuroimaging, stroke specialists and time-sensitive treatments, such as acute thrombolysis and endovascular therapy. (Canadian Best Practice Recommendations, June 2015)
A coordinated and integrated approach to hyperacute stroke care is emphasized within the West GTA Stroke Network, initiatives collaborating with Emergency Medical System, emergency departments, and other stakeholders involved in this phase of care.
Acute Stroke Care refers to the key interventions involved in the assessment, treatment or management, and early recovery in the first days after stroke onset.
The primary aims of the acute phase of care are to identify the nature and mechanism of stroke, prevent further complications, promote early recovery and in the case of the severest strokes provide end-of-life care. Secondary prevention plans and engagement with patients and family to transition to the next level of care is undertaken.
Working Together with Stroke Survivors and their Caregivers to Achieve Optimal Outcomes is imperative across stroke systems of care, with the participation of individuals with stroke, their families and caregivers, healthcare providers, and the broader community. The primary underpinnings of ‘acute inpatient stroke care’ are to optimize recovery and patient outcomes (Canadian Best Practice Recommendations, October 2015)
Acute Inpatient Stroke Care
Achieving optimal outcomes for stroke survivors requires patients to be cared for on dedicated inpatient stroke units by healthcare team members with specialized stroke training, and establishment of evidence-based stroke protocols for all aspects of stroke care, including team meetings with case reviews, and early access to rehabilitation assessments and therapies. Hospitals that manage stroke patients and currently do not have dedicated stroke units should strive to implement all the core elements of stroke unit care, regardless of whether there is a designated stroke unit, and at least cluster stroke patients within a consistent area of a hospital ward and provide staff with education and skills training specific to stroke care. In hospitals where this goal is not possible within, acute stroke patients should be transferred to the nearest hospital that does provide acute stroke unit care. (Canadian Best Practice Recommendations, October 2015)
- The Canadian Neurological Scale (CNS), or
- The National Institutes of Health Stroke Scale (NIHSS)
- Understanding Alberta Stroke Program Early CT Score (ASPECTS)
- Dysphhagia Screening Tool (STAND)
- Depression Screening
STROKE BEST PRACTICES IN ACUTE
HOT TOPICS IN ACUTE
EVIDENCE BASED RESOURCES
Acute Operational Committee
This area is utilize by the Acute Operational Committee members to communicate and share resources. If you are an operational committee member, please click on the button below.