September 16 th , 2010

1. Outpatient Vascular SummitStroke Recheck Clinic PresentationWendy Archambault M-SLP, Reg. CASLPO, S-LP (C) Speech-Language Pathologist September 16th, 2010

2. Stroke Recheck Clinic History of clinic: • 1st clinic was in May 2009. • Clinic falls under the Rehabilitation & Transitions Program at HRSRH. • Clinic is a service of the Geriatric and Day Hospital. • Mandate of clinic remains as per initial structure.

3. Stroke Recheck Clinic Goals of clinic: • To follow clients throughout the transition home and in the community upon discharge from the Intensive Rehabilitation Unit to promote and facilitate: • Adequate follow-up at home • Community re-integration • Decrease falls • Decrease hospital re-admissions • Maximize quality of life • Make recommendations re: caregiver burnout...

4. Stroke Recheck Clinic Patient Population • Inclusion and exclusion criteria developed (trial basis) • Confirmed diagnosis of stroke • Residents of Northeastern Ontario • Consenting and willing • Living in home or residential environments (LTC excluded at this time) • Medically stable • Physician’s order as well as inter-disciplinary referral form required

5. Stroke Recheck Clinic Patient Population: • Patients are referred upon discharge from the Intensive Rehabilitation Unit (IRU). • In accordance with Heart and Stroke best practice guidelines, follow-up appointments occur at approximately 6 weeks, 3 months and 1 year post discharge from IRU. • Clinics are on Thursday afternoons in outpatient department at HRSRH to allow for Physiatrist support.

6. Stroke Recheck Clinic Staffing • Limited staff allocation: 0.4 Physiotherapist, 0.2 Occupational Therapist, 0.2 Speech-Language Pathologist (flexing from other caseloads). • Social Work, Recreation Therapy, Registered Dietitian, Registered Nurse and other staffing not allocated but available for consultation as needed.

7. Stroke Recheck Clinic Current Patient Volumes • Up to 4 patients are seen in each weekly clinic. • Initially clinic was biweekly but frequency has increased to accommodate increased referrals. • There is no waitlist but wait times for recheck appointments sometimes exceed best practice recommendations due to patient volumes. • Patient volumes tend to flex based on number of stroke patients discharged from IRU. • To date 60 patient’s have been referred to this clinic.

8. Stroke Recheck Clinic Patient Journey: • Upon arrival at clinic patient and family member register at outpatient rehab reception and are given a Stroke Impact Scale to complete. • Patient then meets with OT, PT and SLP for 45 minute appointment (complete inter-disciplinary follow-up assessment, team discussion, and documentation and initiate referrals as needed). • Questions are asked to determine currently level of function in each discipline (e.g. equipment, mobility, communication, dysphagia, cognition, community reintegration, etc.). • Current supports in place at home are identified.

9. Stroke Recheck Clinic Patient Journey: • Gaps in service are identified and referrals are made as appropriate (e.g. OBIRS, ICAN, VON Day Centre, CCAC, Hand transit, CNIB, Outpatient OT/PT/SLP, YMCA – Support Group, Diabetes Education, Cardiac Rehab, etc.). • As needed, Dr. Graham, Physiatrist, or other allied heath team members are asked to consult in clinic. • Patient is scheduled for next recheck appointment. • Summary report from clinic sent to Dr. Graham and MRP after 1st clinic and thereafter as needed.

10. Stroke Recheck Clinic Relationships Established with other HRSRH Programs/Clinics: • Referrals initiated from IRU. • Patient often referred to other outpatient clinics at HRSRH and in the community.

11. Stroke Recheck Clinic Future Direction of Clinic • Plan to move to 1 full day or 2 half-day weekly clinics as volumes continue to increase. • Possible opening of clinic to referrals from other sources (e.g. Stroke Prevention Clinic). • Approval of Service Description Policy

12. Stroke Recheck Clinic Future Direction of Clinic • Maintenance of patient database to consistently track stats and measure impact on stroke clientele. • Distribution of education about the Stroke Re-check Clinic. • Improve partnerships with community providers.

13. Stroke Recheck Clinic QUESTIONS

14. Outpatient Vascular SummitOutpatient Occupational Therapy Brenda Seguin O.T. Reg. (Ont)Occupational Therapist September 16th, 2010

15. Outpatient Occupational Therapy Patient Population: • Stroke (upper extremity treatment, cognitive, perceptual and visual assessment and treatment) • Spinal Cord injury and disease (upper extremity treatment, splinting) • ABI (splinting and upper extremity treatment) • Cognitive Impairment (dementia) • Congenital disorders such as C.P. , developmental delays,.. • Age varies from 18 and over

16. Outpatient Occupational Therapy Current Patient Volumes • Outpatient services are available in the afternoon only (0.5 FTE) • Usually see 7-9 patients per week + the stroke re-check clinic (1x per week) • Waitlist varies according to type of referrals and current caseload i.e. 1hour sessions vs 1/2hour session

17. Outpatient Occupational Therapy Patient Journey: • Referral from a physician or nurse practitioner • Client is placed on a wait list and then called at home to set up an appointment • Registers at the rehab outpatient reception desk • Assessment by the O.T. • Establish goals of therapy

18. Outpatient Occupational Therapy Examples of goals for the upper extremity: • Increase strength, coordination, fine motor skills and/or • Stimulate and/or Increase active/normal movement • To decrease tone (spasticity) in the shoulder, wrist, hand, fingers • Increase functional use of the UE

19. Outpatient Occupational Therapy Other interventions: • Splinting to provide positioning of the Upper extremity • Splinting to prevent or reduce contractures • Hand and/or wrist positioning aids to protect the palm from infection, odor, injury,…

20. Outpatient Occupational Therapy Relationships Established with other HRSRH Programs/Clinics • Outpatient physiotherapy • Hand and Upper Limb Rehabilitation • Stroke re-check clinic • DARS (Driving Assessment and Rehabilitation Service) • Referrals often initiated from IRU and from the stroke team on acute care units

21. Outpatient Occupational Therapy Future Direction of Program • Link with the new Geriatric Day Hospital • Possible partnership with the seating clinic re:wheelchair prescription that do not need the specialty of the seating clinic.

22. DARS Driving Assessment Rehabilitation Service • Assessment for safety to drive a vehicle • Assessment for driving adaptations such as hand controls, left gas pedal, spinner knob • Vision Waiver Functional Assessment (specific protocol established by MTO) • Vehicle Adaptation and Modification Assessment

23. DARS Most common referrals: • Stroke • ABI • Dementia Less common referrals: • Amputee • Paraplegia • M.S., Parkinsons

24. DARS • Referral from a physician • Fee for service (not covered by OHIP) • Includes a clinical assessment by an OT and followed by an on-road evaluation with a driving instructor and the OT. • Use of the driver instructor’s vehicle with a dual brake (NOT the client’s vehicle) • Report is sent to referring physician, other physician as instructed by the client, MTO and the client.

25. DARS Possible Outcomes: • Continue or resume driving if MTO and physician agrees • Driving lessons and repeat road test • MTO road test • Driving with adaptations • No driving recommended

26. DARS • For more information and for the referral form, please contact the secretary: Lise Morrissette ext. 7098

27. Thank you!

28. Outpatient Vascular SummitCardiac Rehab September 16th, 2010

29. Cardiac Rehabilitation Program History 1970’s - Community-based program at Laurentian University, then moved to community fitness facility “Connie Lou’s Gym”.

30. Cardiac Rehabilitation Program 1985 • Program Moved to Sudbury Arena as part of the Cardiovascular Program.

31. Cardiac Rehabilitation Program 1991 • Recovery program established in the Medical Arts Building.

32. Cardiac Rehabilitation Program 2000 • Programs combined at Centre for Life.

33. Cardiac Rehabilitation sits within the HRSRH Critical Care Program

34. Initial mandate To assist with the modification of risk factors in patients with established coronary disease in an effort to prevent disease progression and recurrence of cardiac events.

35. Current mandate To provide interventions to enhance and maintain • Physical • Psychological • Vocational Status of individuals with established heart disease or those at high risk for the development of heart disease for both local and regional clients.

36. Multidisciplinary Model • Medical Director • RN EC • RN • Clinical Exercise Specialist • PT • Kin • RD • Psychological Associate

37. Client Inclusion Criteria MI Stable angina CABG PTCA Compensated Heart Failure Cardiomyopathy Transplant Valvular Arrythmias Pacemaker/ICD PAD

38. Programs offered Education Exercise: Aerobic & Resistance Smoking Cessation Heart Failure Stabilization Regional Satellites Hydrotherapy PAD Home Program Vocational Chronic Disease Patient Self Management

39. Client Population ** Average client age- 62 years

40. Referral Location Covers an area of approximately 185,000 km2

41. Satellite Programs Espanola Little Current Sturgeon Falls Kirkland Lake New Liskeard Sault Ste. Marie

42. Total Referrals 2003-2010 Hundreds

43. Client Visits Thousands

44. Client Journey Referral Risk Stratification Intake Multi-Disciplinary Intervention Diagnostic Testing Case management Exercise On site Home Education On site Web cast OTN Reassessment Discharge

45. Relationships Established with other HRSRH Programs/Clinics Pulmonary Rehab Community Asthma Clinic Diabetes Education Nutrition Counselling Pre-admission Respiratory therapy Cardiology Cardio diagnostics Stroke clinic/Vascular unit ABI Tobacco Cessation

46. Future Direction • Enhanced Heart Function Clinic • Expansion of Pulmonary Rehab

47. Collaboration • New linkages with other clinics and/or patient populations

48. Outpatient Vascular SummitStroke Prevention Clinic September 16th, 2010

49. Stroke Prevention Clinic 2 minute history of clinic: • Date started: April 2006 • Initial mandate: Provide timely access to diagnostic and medical follow-up for patients presenting with a recent transient ischemic attack (TIA) to prevent progression to a completed stroke • Part of Emergency and Medical Program • Location: Neurology/Stroke Prevention Clinic – 1st Floor South Tower

50. Stroke Prevention Clinic Patient Population: • Diagnoses followed: • TIA (Transient Ischemic Attack) • Non-disabling stroke • Average age = 65 years • Male/female split = 50/50 • Referrals received from (2009/10 data) • HRSRH ED (42%) • HRSRH Inpatients (27%) • Sudbury and Area Physicians (24%) • Community Hospital ED’s (7%)