Abstract WP508: Improved Access to Stroke Care in Saskatchewan Canada

Abstract

Background: The province of Saskatchewan, Canada represents a large geographic territory with 1.2 million residents. Approximately 2000 Saskatchewan residents per year are hospitalized due to stroke, with care being provided at a variety of facilities. Method: The Saskatchewan Acute Stroke Pathway (ASP) was established to implement Canadian Stroke Best Practice Recommendations (CSBPR) province wide. Recommendations included: creation of primary and comprehensive stroke centers, expansion of emergency medical service (EMS) stroke alert bypass window, increased use of telehealth technologies, twenty-four-hour access to computer tomography and angiography, standardized assessment, and diagnostic and treatment tools that integrate best practice guidelines into workflow. All stroke centres are accountable to report key metrics. Results: A significant improvement in access to acute stroke care was achieved. Eight primary stroke centres (PSC) and 1 comprehensive stroke centre (CSC) were established, and a 12 hour EMS bypass window was implemented. EMS adopted the FAST tool to correctly identify stroke patients 78% of the time. Sixty-eight percent of patients arrived at the stroke centre within 4.5 hours of symptom onset, in 2016. The median provincial door to needle time decreased from 82 minutes to 66 minutes. Pathway implementation saw an increase in mechanical thrombectomy from 42, in 2016 to 70 per year in 2017. Conclusion: Standard processes were adopted by all stroke centers. Lower volume centres continue to experience challenges in meeting CSBPRs resulting in ongoing improvement work. The primary limitation has been resistance to CTA and limited use of existing telestroke resources. Transfer of patients requiring endovascular therapy has improved provincial mechanical thrombectomy numbers to 58 patients per 1 million population. Further process improvements are focusing on increasing access to this service from more remote centers. Our results show that the implementation of a comprehensive provincial acute stroke pathway leads to significant improvements in access to optimal care.