In the 10 years since the Stroke Services BC program was launched in 2011, plenty of high-impact events have taken place around the globe.
But for thousands of stroke patients and their families here in BC, the arrival of the program team and the work they’ve done has likely had a more profound impact, in many instances on their ability to function day-to-day. It’s a team that’s been described as “small but mighty” by people who work on stroke care elsewhere in the country.
Including professionals like Dr. Patrice Lindsay, Heart & Stroke Foundation of Canada’s Director of Health Systems Change who has spent close to two decades working on stroke awareness, research, rehabilitation and treatment on a national level before Stroke Services BC even existed, giving her a clear view of the team’s achievements.
“The BC team has excelled in their leadership of getting funding for things like FAST (stroke awareness) over the years and developing and pushing it into the public domain,” she says.
BC Emergency Health Services Chief Medical Officer, Dr. Wilson Wan, has also worked closely with the program team over the past few years, and agrees wholeheartedly with Patrice’s assessment. For him, one of the Stroke Services BC team’s biggest achievements has been developing the provincial care standard for strokes.
“Making sure all patients get access to high-quality stroke care in a timely manner based on an established provincial standard is extremely important,” he says. “This equitable approach is vital to all British Columbians,” something he attributes to the program team’s support for paramedic practitioners as part of the stroke system of care to adopt and use the measures across the province.
Interior Health Authority Director of Stroke Care, Cory Bendall, agrees, having spent most of her career working outside of the Lower Mainland in rural and remote settings where specialized resources can be hard to come by. She’s seen first-hand the impact the program has had on the care patients receive, regardless of whether they hail from the rapidly growing city of Kelowna or an incorporated hamlet like Yahk.
“By supporting every health authority in the province to adopt stroke best practices, we really have improved care of all stroke patients in BC along the continuum of care." – Cory Bendall
One clear example for Cory is the adoption and support of EVT (Endovascular Therapy Treatment), a highly successful procedure that reduces death and disability from major strokes in patients who experience a blood clot within a large vessel (artery) of the brain.
“With the work to establish an EVT service in the interior, both in conjunction with Stroke Services BC as well as colleagues from BC Emergency Health Services and other health authorities, we’ve been able to drop the average length of stay in hospital for all ischemic stroke patients by six days” she says.
“Almost half of our EVT patients coming from outside of the Kelowna area – and with the creation of the Interior Health Stroke Network of services the cost avoidance has been estimated at more than $5M while providing better service and creating improved patient outcomes.”
Cory has been involved in care areas where there isn’t a provincial body, and has seen how difficult it can be to engage fellow professionals around improving best practice. But she’s quick to note, “The program’s impact goes beyond best practices to include key supports like data capture and cross-professional quality improvement forums.”
Patrice also points to the team’s series of quality improvement forums, work that she calls, “an exemplary initiative because of how they’ve really helped accelerate change in the province.”
“They’ve done an excellent job of bringing people together, setting up the environment for relationship building and collaboration,” she says. “They’ve also looked at stroke care holistically and developed a multi-pronged approach to data, evidence and partnerships.”
Wilson has experienced the team’s ability to partner with other organizations, as he’s worked closely in conjunction with the BC Emergency Health Services team for about 18 months to develop Provincial Pre-Hospital Transport and Triage Guidelines for Adult Stroke Care last year.
“This was a huge amount of work, done in conjunction with each health authority, that ensures stroke patients get access to high-quality care as quickly and efficiently as possible.” – Wilson Wan
With each health authority having different facilities and processes, the groups have prepared preferred care pathways that, in some cases, result in paramedic teams bypassing one facility for another with the advanced stroke care capabilities, to decrease time from onset of stroke to specialized treatment even if the site is further away. Wilson is confident these customized routes to getting stroke patients treated appropriately will save lives and reduce disability caused by stroke.
He’s also clear that the team’s approach to working with its partners like BC Emergency Health Services and its paramedics is a significant part of why the cooperation is effective.
“Having the paramedics involved in the development process has been a win,” he says. “We’re integrating their views into the planning and development process, which makes for a better overall solution.”
Stroke Services BC Provincial Director, Sacha Arsenault, agrees on the importance of effective collaboration, and highlights the important role that partners who have experienced a stroke also play in helping guide the team’s efforts.
“People with lived experience are one of our best sources of knowledge when it comes to how we can work together not only at the bedside, but also at the health system level to improve the overall stroke system of care,” she says.
“The insights they’ve shared have been instrumental in creating change.” – Sacha Arsenault
As timely as it is to look back at past accomplishments at the team’s 10-year milestone, it’s equally insightful to look ahead and ponder what kind of impact the program team will deliver in its second decade.
For Wilson, he sees the program team evolving and continuing to build on the strong relationships they’ve been growing since 2011.
“There are plenty of opportunities for innovation and research with BC Emergency Health Services,” he says, as someone who sees this deeper collaboration benefiting stroke patients and their families.
“From further research projects to examining how we might integrate video technology into the pre-hospital environment, to potentially enable stroke teams to offer input into a paramedic’s field assessment."
From the perspective of the Heart & Stroke Foundation of Canada, Patrice hopes the team continues the work it’s started, going beyond the areas they’ve concentrated on already.
"They’ve done a great job on the acute care and early rehabilitation phases of the stroke continuum,” she explains.
“I see them continuing the journey they’ve been on and turning their attention to longer term recovery, support and adaptation of people living with stroke." – Dr. Patrice Lindsay
Sacha appreciates the feedback the team has received from its partners and acknowledges that at least the first few years of the program team’s second decade have already been mapped out.
“Based on the results of a provincial stroke review process done in 2019, together with our partners, we’ve built a multi-year action plan that will guide our efforts for the next three years,” she explains. The work will include:
Expanding the newly launched Stroke Treatment Registry – enabling the program team and partners to understand how the system is performing at a provincial, regional and local site level. This will support partners in targeted quality improvement efforts in areas where traditionally there’s little or no data.
- Developing a provincial stroke rehabilitation & recovery strategy – by working closely with partners to improve access to timely and comprehensive rehabilitation across the continuum.
- Continuing to grow partnerships – with organizations like BC Patient Safety & Quality Council to launch Provincial Stroke Quality Standards that clearly articulate what it means to provide and receive high-quality stroke care in BC.
- Ongoing focus on acute care – with a focus on optimizing access to best practice stroke unit care delivered in hospitals to improve outcomes by decreasing mortality and post-stroke disability.