August 27, 2020 | 11:30 am – 12:30 pm Teleconference: (647) 951-8467 or Long Distance: 1 (844) 304 - 8099 Conference ID: 591413351#
Time Description Purpose Presenter / Facilitator 11:30 1. Welcome Sheila Jarvis Meeting Objectives Information • CorHealth System Updates • 11:40 2. Update on ED Stroke Data Overview of ED data (eCTAS & IDS) Information/ Mirna Rahal • Stroke Symptom Onset Discussion • Arrival By Ambulance • 11:55 3. Program Sharing: Hybrid Models of Care Karen Beekenkamp, Social worker, Outpatient • Stroke Service at Toronto Rehab, UHN Information/ Dr. Leanne Casaubon Edith Ng, Advance Practice Leader, Brain Services, Discussion Edith Ng and Karen Beekenkamp • Toronto Rehab Q&A • 12:10 4. Lessons Learned: Preparation for Future Waves Information/ Dr. Leanne Casaubon Discussion 12:25 5. Next Steps and Wrap Up Dr. Leanne Casaubon 2
SHEILA JARVIS
• To provide information on key CorHealth and System updates. • To share an update on data related to emergency room presentation of stroke and stroke symptom onset. • To facilitate dialogue and share experiences on the current activities and models of delivery for stroke outpatient rehabilitation (including virtual, in person and hybrid models) • To reflect on the stroke system’s response to the first wave of COVID -19 and considerations for addressing future waves 4
• Met with Dr. Chris Simpson in late July and mid August to discuss the new report he and his team are working on. It will focus on maintaining care throughout the phases of COVID-19. • Subsequent meetings with Dr. Simpson will be scheduled in September to get an update and provide support where possible. Dr. Leanne Casaubon will be invited to those meetings. • CorHealth COVID-19 Stroke Memo #5 – Recommendation for an Approach to Ramping Up In-Person Secondary Stroke Prevention Clinic Services in Ontario was posted to the CorHealth website on August 25 th . 5
MIRNA RAHAL
MONTHLY NACRS AND DAD DATA, MARCH & APRIL 2020 COMPARED TO 2019 DATA EXTRACTION DATE: AUGUST 20 TH , 2020
Stroke ED Visits and Subsequent Admissions 2,000 1,800 1,600 764 1,400 1,200 1,000 448 800 600 1,097 400 768 200 - Apr-19 Apr-20 ED Visits Admitted ED Visits -Not Admitted Stroke activity for April 2020 compared to April 2019: Data Source: IDS Hamilton 35% decline in Stroke related ED visits and 30% in in associated hospital admissions 8 Note: Following HSP’s excluded due to missing data for April 2020 (Halton Healthcare Services Corporation)
Stroke ED Visits and Subsequent Admissions 2,000 1,800 1,600 681 1,400 1,200 466 1,000 800 600 1,085 400 817 200 - May-19 May-20 ED Visits Admitted ED Visits -Not Admitted Stroke activity for May 2020 compared to May 2019: Data Source: IDS Hamilton 27% decline in Stroke related ED visits and 25% in in associated hospital admissions Note: Following HSP’s excluded due to missing data for May 2020 (William Osler Health System, Halton Healthcare Services Co rporation, Haldimand War Memorial Hosp, 9 St Josephs Healthcare Sys-Hamilton, TEGH, Health Sciences North, Windsor Regional Hospital
ED Visits - Total (By Mode of Arrival) 1200 1,011 1000 812 749 800 600 466 400 200 <=5 0 A - Air Ambulance C - Combination of air and ground ambulance G - Ground ambulance N - No ambulance arrival (walk-in) May-19 May-20 Data Source: IDS Hamilton Stroke activity for May 2020 compared to May 2019: 20% decline in Ground ambulance related ED visits and 38% reduction in Walk-ins Note: Following HSP’s excluded due to missing data for May 2020 (William Osler Health System, Halton Healthcare Services Co rporation, Haldimand War Memorial Hosp, 10 St Josephs Healthcare Sys-Hamilton, TEGH, Health Sciences North, Windsor Regional Hospital
Stroke ED Visits - Not Admitted Stroke ED Visits – Admitted 450 416 400 37% 800 746 reduction 350 700 18% decline in walk-ins 610 in Ground 39% 300 600 24% decline 265 264 ambulance reduction 500 250 in Ground related ED in walk-ins 202 ambulance visits 400 200 333 related ED 300 visits 150 202 200 100 100 <=5 <=5 50 0 0 A - Air Ambulance C - Combination of air G - Ground ambulance N - No ambulance A - Air Ambulance C - Combination of air G - Ground ambulance N - No ambulance and ground ambulance arrival (walk-in) and ground arrival (walk-in) ambulance May-19 May-20 May-19 May-20 Data Source: IDS Hamilton Note: Following HSP’s excluded due to missing data for May 2020 (William Osler Health System, Halton Healthcare Services Co rporation, Haldimand War Memorial Hosp, 11 St Josephs Healthcare Sys-Hamilton, TEGH, Health Sciences North, Windsor Regional Hospital
Ontario 4.0 3.5 3.0 Median Time (Hrs.) 2.5 2.0 1.5 1.0 0.5 - Jan Feb Mar Apr May Jun 2019 2020 Data Source: IDS Hamilton 12
Central West LHIN Erie St Clair LHIN South West LHIN 6.0 4.0 7.0 3.5 6.0 5.0 Median Time (Hrs.) Median Time (Hrs.) Median Time (Hrs.) 3.0 5.0 4.0 2.5 4.0 3.0 2.0 3.0 1.5 2.0 2.0 1.0 1.0 1.0 0.5 - - - Jan Feb March April May June Jan Feb March April May June Jan Feb March April May June Toronto Central LHIN HNHB LHIN Mississauga Halton LHIN 6.0 5.0 3.5 3.0 5.0 Median Time (Hrs.) Median Time (Hrs.) Median time (Hrs.) 4.0 2.5 4.0 3.0 2.0 3.0 1.5 2.0 2.0 1.0 1.0 1.0 0.5 - - - Jan Feb March April May June Jan Feb March April May June Jan Feb March April May June Data Source: IDS Hamilton 13
A GLIMPSE INTO THE EMERGENCY DEPARTMENTS FOR STROKE PRESENTATIONS
Extremity Weakness/Symptoms of CVA, Total Volumes 800 PANDEMIC 714 707 697 684 682 700 667 664 659 656 648 648 646 642 640 638 629 631 618 616 614 609 610 597 596 592 592 593 592 600 559 537 509 493 500 470 465 448 428 421 400 300 200 100 0 Extremity Weakness / Symptoms of CVA Data Source: eCTAS Note: The week of July 04 th data is excluded from all the eCTAS stroke graphs. Due to a technical disruption on July 4th, a selection of Ontario Health products including eCTAS were unavailable for an extended period of time. As a result, daily triage volume is significantly understated (estimated ~40% lower) in all eCTAS reporting for July 4th. The week containing August 7th, data is excluded from all graphs, a portion of eCTAS hospitals were unavailable for an extended period of time. As a result, ~1000 15 records were not transmitted to eCTAS.
Extremity Weakness/Symptoms of CVA, By CTAS Level 400 PANDEMIC 350 300 250 200 150 100 50 0 CTAS1 CTAS2 CTAS3 Data Source: eCTAS 16
Extremity Weakness/Symptoms of CVA, By Age Group 400 PANDEMIC 350 300 250 200 150 100 50 0 Ages 0 - 29 Ages 30 - 49 Ages 50 - 69 Ages 70+ Data Source: eCTAS 17
PANDEMIC Data Source: eCTAS 18
DR. LEANNE CASAUBON GUEST SPEAKERS: KAREN BEEKENCAMP AND EDITH NG, TORONTO REHABILITATION INSTITUTE, UHN
Outpatient Stroke Rehab August 27, 2020 Karen Beekenkamp Edith Ng Social Worker Advanced Practice Leader
Who we are • Urban, academic rehabilitation setting University Centre Rumsey Centre Neuro – Inpatient Stroke Rehab – Outpatient Stroke Rehab – Fast Track • typically 2- 3 times/week • Early Supported Discharge (ESD) Outpatient Service • typically 4-5 times/week – Stroke Day Hospital • typically 2- 3 times/week March & April 2020 • Redeployment of most outpatient staff • Closure of In-Person Outpatient Rehab • Virtual Outpatient Rehab Only
Our Outpatient Services – Aug 2020 Aug 2020 • Primarily providing virtual care for OT, PT, SLP & SW • As of Aug 10 th , a small number of in-person Stroke outpatient services began – Rumsey Centre (RC) for Day Hospital & Outpatient – University Centre (UC) for Fast Track • Now increasing in-person therapy to 25% capacity • Fledgling stages of hybrid care, as cases dictate • Other in-person outpatient services re-started: – Neuropsychology – Physiatry
In-Person Outpatient Visit Planning 1. Altered space allocations to prepare for safe in- person care and to maximize virtual treatment space – Eliminate patients being seen in staff offices – Separate inpatient and outpatient treatment spaces 2. Developed priority matrix to prioritize wait list for in- person services across 2 sites, 2 current outpatient teams, and 3 Stroke outpatient services: Fast Track, UC Day Hospital, & RC Outpatient 3. Initiated return of some redeployed outpatient staff to maintain capacity to provide virtual care AND to increase in-person outpatient services
Optimizing Safe In-person Visits • Phone call before in- • Designated in-person person visits to: washrooms, treatment & waiting areas – Confirm need for • Sanitization of hands and service(s) treatment space – Clarify expectations before/after session • Masks • Reduced session length to • Screening allow time for sanitization • Essential visitors only and transit for patient and – Answer questions staff • Screening at the entrance • PPE available as • Provide masks for all intervention dictates outpatients and visitors
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