Southeastern Ontario
H H H
O H H H H
tPA sites H H Regional Stroke Centre H H H District Stroke Centre H H H H using telestroke
H Community hospital H using telestroke
In- hospital stroke protocol activations 13 at KGH; 5 at QHC KGH DTN time 47 mins; QHC 67 mins in FY 13-14 NB - value of EMS pre-notification!!
Median DTN time Dec 2010-Dec 2014 = 63 mins Ave Door to CT time 14.3 mins NB – EMS accompany patient to CT - saving the brain
Public Release June 18th 2015
Ontario Stroke Evaluation FY 13-14 ◦ CIHI administrative data ◦ CIHI 340 – stroke data
N=136
N = 66
N = 69
N = 74
N = 21 NEW! Stroke Units opened in Brockville Dec 2013 and Belleville June 2014; Napanee transfers to KGH unit
2013
QHC- KGH TOH CCH PRHC TOTAL B Public Awareness: 0- 30 mins 7 7 14 ASP calls 31- 60 mins 46 44 3 1 94 symptom onset to 61- 90 mins 40 52 12 1 105 arrival at a stroke 91- 120 mins 18 35 15 1 69 centre 121-210 mins 16 42 16 1 75
Greater than 3.5 1 1 1 hrs 3 2014 Total 128 181 47 3 1 360 QHC- KGH TOH CCH PRHC TOTAL B
0- 30 mins 5 3 8 31- 60 mins 30 43 8 81 61- 90 mins 34 41 24 1 104 91- 120 mins 25 44 9 79 121-210 mins 28 57 16 104 Greater than 3.5 hrs 3 7 10
Total 125 195 57 6 3 386 66% 67% 67% 60% 62% 50%
55% 55% 46% 56% 51% 51% 62%
41% 25%
Frontenac Hastings-Quinte Lanark Leeds-Grenville Lennox & Prince Edward Addington County
2012 2013 2014 ACUTE STROKE PROTOCOL PATIENTS (n=360) RESPONDING AMBULANCE SERVICE 2013
Lennox & Addington ASP stroke calls 6% by location Leeds Grenville Frontenac 18% 25% N=360
Hastings-Quinte 36% Lanark County 15%
ACUTE STROKE PROTOCOL PATIENTS (n=386) RESPONDING AMBULANCE SERVICE Lennox & Addington 7% Leeds-Grenville 19% Frontenac 2014 22%
Lanark County ASP stroke calls by Hastings-Quinte 19% location 33% N=386 Location of ASP Stroke Calls within each County by Calendar Year
Frontenac Hastings-Quinte Lanark Leeds & Grenville Lennox & Addington Prince Edward
120 HQ N = 113
100
Fr N = 82 80 LG N =80
60 Lanark N=66
40
L&A N = 27 20 PE N = 15
0 2007 2008 2009 2010 2011 2012 2013 2014
2009 2010 2011 2012 2013 2014 Stroke Centre 74 74 129 161 176 165 closest (33%) (34%) (44%) (46%) (49%) (43%) hospital Bypassed 112 106 115 133 146 135 (50%) (48%) (39%) (38%) (40.5%) (35%) Transferred 44 39 49 56 38 86 (17%) (18%) (17%) (16%) (10.5%) (22%) TOTAL 223 219 293 350 360 386
Reasons for the 86 transfers in 2014: 47 brought by private car (compared to 18 in 2013) Home location for these 47 patients: 3 unknown how arrived in ED Almonte 4 Napanee 5 15 in-hospital strokes (4 in 2013) Bancroft 5 Perth 9 4 Brought to ED by ambulance after TIA recurred in ED Brockville 4 Picton 3 17 others brought to ED (4 GSC<10; 2 seizures; 2 confusion only; Carleton Place 1 Smiths Falls 7 3 UTD onset; 2 outside time window; 1 CVA in ED; 1 unstable; Kemptville 4 Trenton 4 1 STEMI; 1 symptoms unclear) Kingston 1 www.strokenetworkseo.ca
Responding Ambulance Service (n = 852)
Lennox & Addington EMS Leeds Grenville EMS 57 Frontenac Paramedic 2013 166 7% Service 19% 219 26% ALL stroke calls by location N=852 Lanark County Ambulance 118 14% Hastings-Quinte EMS 292 34%
Responding Ambulance Service (n = 962)
Lennox & Addington EMS Leeds-Grenville 71 Frontenac Paramedic Paramedic Service 7% Service 190 236 2014 20% 25% ALL stroke calls by location
Lanark County Paramedic N=962 Service 159 Hastings-Quinte 16% Paramedic Service 306 32% Location of ALL Stroke Calls within each County by Calendar Year
Frontenac Hastings-Quinte Lanark Leeds & Grenville Lennox & Addington Prince Edward
260 HQ N = 254 240 Fr N = 232 220
200 LG N = 207
180
160 140 Lanark N=136 120
100
80 L&A N = 73 60 PE N = 49 40
20 2007 2008 2009 2010 2011 2012 2013 2014