Saving costs using an ounce of prevention: introduction of a regional stroke prevention clinic.

Trillium Health Centre (THC) is one of Canada's largest community hospitals and a regional provider of tertiary-level cardiac, neuroscience, and orthopedic care. In 2001, it was named one of nine Regional Stroke Centres in Ontario, with a mandate to coordinate stroke services across the continuum of care in keeping with best practices in the west Greater Toronto Area (GTA). Within its role as a Regional Stroke Centre, THC has successfully implemented an innovative approach to the delivery of stroke prevention services in its regional catchment area. Building on best practices, it has introduced a specialized and interdisciplinary team to provide timely and effective primary and secondary prevention services. The rapid growth in utilization to more than 2000 patients in the last fiscal year (2004-2005), suggests that the clinic is meeting a real need in the community for stroke prevention services. Many of these patients now benefit from appropriate medical management, stroke awareness education, lifestyle counselling, and expedited referrals to other specialists. The Regional Stroke Prevention Clinic (RSPC) may be the first step in preventing a stroke, thus avoiding the social costs to people with strokes and their families, and the financial burden on the health care system.

Bringing innovation to stroke care: development of a comprehensive stroke unit.

Much work has been done in the past 10 years to research and document best practices in stroke care along the continuum of care. The challenge now for stroke care practitioners is to turn those best practices into reality in a clinical setting. In spite of a general understanding and acceptance of the benefits to the patient, an organization's culture and limited access to resources can frustrate our best efforts to introduce best practices at the bedside. Trillium Health Centre, a community hospital serving a diverse community of more than one million people, has turned best practice stroke care guidelines into reality by developing a 14-bed comprehensive stroke unit. This innovative approach to care uses specialized stroke teams, an interdisciplinary approach to care, and a single unit where the patient remains in the same bed throughout the acute and rehabilitation stages of care. Commitment to the new delivery model by formal leaders, informal leaders, and front-line staff and a supportive organizational structure contributed to an expedited and successful implementation. All changes were implemented without an increase in the overall resources assigned to the unit. Early results show that the average length of stay is shorter than the national standard and that provider and patient satisfaction have improved.