Hôpital régional de Sudbury Regional Hospital
Outpatient
Vascular Summit
Stroke Recheck Clinic
Presentation
Wendy Archambault
M-SLP, Reg. CASLPO, S-LP (C)
Speech-Language Pathologist
September 16th, 2010
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.
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:
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Adequate follow-up at home
Community re-integration
Decrease falls
Decrease hospital re-admissions
Maximize quality of life
Make recommendations re: caregiver burnout...
Stroke Recheck Clinic
Patient Population
• Inclusion and exclusion criteria
developed (trial basis)
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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
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.
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.
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.
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.
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.
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.
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
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.
Stroke Recheck Clinic
QUESTIONS
Hôpital régional de Sudbury Regional Hospital
Outpatient
Vascular Summit
Outpatient
Occupational Therapy
Brenda Seguin O.T. Reg. (Ont)
Occupational Therapist
September 16th, 2010
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
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
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
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
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,…
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
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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.
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
DARS
Most common referrals:
• Stroke
• ABI
• Dementia
Less common referrals:
• Amputee
• Paraplegia
• M.S., Parkinsons
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.
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
DARS
• For more information and for the
referral form, please contact the
secretary:
Lise Morrissette ext. 7098
Thank you!
Hôpital régional de Sudbury Regional Hospital
Outpatient
Vascular Summit
Cardiac Rehab
September 16th, 2010
Cardiac Rehabilitation Program
History
1970’s - Community-based program at Laurentian
University, then moved to community fitness facility
“Connie Lou’s Gym”.
Cardiac Rehabilitation Program
1985
• Program Moved to Sudbury Arena as part of the
Cardiovascular Program.
Cardiac Rehabilitation Program
1991
• Recovery program established in the Medical
Arts Building.
Cardiac Rehabilitation Program
2000
• Programs combined at Centre for Life.
Cardiac Rehabilitation sits within
the HRSRH Critical Care Program
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.
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.
Multidisciplinary Model
• Medical Director
• RN EC
• RN
• Clinical Exercise Specialist
• PT
• Kin
• RD
• Psychological Associate
Client Inclusion Criteria
MI
Stable angina
CABG
PTCA
Compensated Heart Failure
Cardiomyopathy
Transplant
Valvular
Arrythmias
Pacemaker/ICD
PAD
Programs offered
Education
Exercise: Aerobic & Resistance
Smoking Cessation
Heart Failure Stabilization
Regional Satellites
Hydrotherapy
PAD
Home Program
Vocational
Chronic Disease Patient Self Management
Client Population
70
60
50
40
Female
Male
30
20
10
0
Gender
** Average client age- 62 years
Referral Location
Covers an area of
approximately
185,000 km2
Satellite Programs
Espanola
Little Current
Sturgeon Falls
Kirkland Lake
New Liskeard
Sault Ste. Marie
Total Referrals 2003-2010
Hundreds
16
14
12
10
8
6
4
2
0
In town
Out of
town
Client Visits
Thousands
18
16
14
12
10
8
6
4
2
0
2005-06
2006-07
2007-08
2008-09
2009-10
Client Journey
Referral
Risk Stratification
Multi-Disciplinary
Intervention
Intake
Diagnostic Testing
Case management
Exercise
Reassessment
Education
On site
Web cast
OTN
Discharge
On site
Home
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
Future Direction
• Enhanced Heart Function Clinic
• Expansion of Pulmonary Rehab
Collaboration
• New linkages with other clinics
and/or patient populations
Hôpital régional de Sudbury Regional Hospital
Outpatient
Vascular Summit
Stroke Prevention
Clinic
September 16th, 2010
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
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%)
Stroke Prevention Clinic
Patient Volumes
• # Referrals to Clinic/Year
Year
# New Pts
# Visits
2006/07
122
174
2007/08
227
287
2008/09
272
448
2009/10
247
507
2010/11
280 (proj.) 560 (proj.)
Stroke Prevention Clinic
Patient Journey:
• Referral Made (e.g. from HRSRH Emergency Dept);
initial education provided through patient folder in
ED
• Appointment date is based on triage level (using
validated tool) – avg. wait 3-7 days
• Prior to 1st visit with physician, each patient is
booked for CT Head, Carotid Doppler, Lab Work
(fasting blood sugar, lipid profile, AST, ALT and CK)
and a nurse visit (includes risk factor education)
• Physician visit – complete neurological examination
– diagnosis – risk factor management – further
testing (e.g. MRI or CTA) if necessary
Stroke Prevention Clinic
Patient Journey (cont’d)
• Follow-up visits in clinic booked for test
results and/or medication review
• Ongoing medical management provided by
family physician
• Orphaned patients remain an outstanding
issue
Stroke Prevention Clinic
Relationships Established with other HRSRH
Programs/Clinics
• Outgoing referrals include
– Vascular Surgery
– Neurology
– Cardiology
– Geriatrician (Dr. Clark)
– Cardiac Rehab
– Smoker’s Helpline
– Nutrition Counselling
– Diabetes Education
– Outpatient Neuro PT and OT
Stroke Prevention Clinic
Future Direction of Clinic/Program
Definite:
1. Develop process to provide more
comprehensive follow-up for discharged acute
stroke patients
(55-60% of stroke admissions at HRSRH are discharged home
from acute care with no formal clinic follow-up)
– 1st Step: follow-up of patients discharged from
acute care by Hospitalist team
– Possible 2nd Step – provide follow-up for patients
discharged by family physicians
- These 2 scenarios would add approximately 140200 new patients/year to the clinic
Stroke Prevention Clinic
Future Direction of Clinic/Program (cont’d)
Possible:
1. In collaboration with Inpatient Stroke Program
– develop a Hypertension Education Program
Stroke Prevention Clinic
Identified Gaps in Outgoing Referrals
• Smoking Cessation Counselling (vs. phone #)
• Wait List issues with Outpatient Neuro OT and
PT
Stroke Prevention Clinic
• Questions?
Hôpital régional de Sudbury Regional Hospital
Outpatient
Vascular Summit
Outpatient Neuro
Physiotherapy
September 16th, 2010
Outpatient Neuro. Physio
2 minute history of clinic:
• Started approximately 20+ years ago
• Physiotherapy assessment and treatment is
provided to individuals with neurological
conditions with the aim of treatment being to
recover function and to help them integrate
safely into the community following
discharge from the rehabilitation unit.
• Individuals from the community who suffer
from neurological conditions, vestibular
dysfunctions or individuals needing a walker
prescription are also seen by this service.
Outpatient Neuro. Physio
Priorities:
• Referrals from Intensive Rehabilitation Unit,
Specialists, and “high fall risk” clients.
• This service falls under the Rehabilitation and
Transitions Program
Outpatient Neuro. Physio
Staffing:
• 0.6 FTE Physiotherapist
Patient Population:
• C.V.A., A.B.I., Spinal Stenosis, Neuropathy,
Amputees, M.S., P.D., Vestibular
Dysfunction,Spinal Stenosis, etc.
Referrals from: Dr. Graham/I.R.U., Specialists,
G.P.’s, Geriatrician-Dr. Clarke
Average Age of Patients: 65
Outpatient Neuro. Physio
Current Patient Volumes:
• 2009- averaged 7 new referrals/mo.
• 2006- averaged 6 new referrals/mo.
Current Waitlist:
• Urgent neuro - 4 weeks
• Semi-urgent neuro - 4 months
• Chronic neuro - 2 years,10 months
Outpatient Neuro. Physio
Patient Journey:
• Client is deemed to need more physio after d/c,
or a new diagnosis.
• In the community, physician makes referral to
outpatients. Screened by secretary to see if
have private coverage.
• 1 hour initial assessment: H.P.I., P.M.HX.,
Discuss: Any issues since d/c, fall hx, pain,
functional limitations, education++ s+s of
stroke, or of their dx./ sequelae.
Outpatient Neuro. Physio
Patient Journey:
• Physical Ax. : strength, ROM, balance, gait ax.,
sensation etc.
• One hour appointments. –work on goals
established at beginning, monitor change and
ascertain well-rounded home ex. program
• May consult with O.T., ABI team, refer for pool
therapy.
Outpatient Neuro. Physio
Patient Journey:
• Refer to: ICAN, VON daycentre, OBIRS.
• May re-check ie. Diagnoses that deteriorate
every 6 months. P.D., M.S.
Outpatient Neuro. Physio
Relationships Established with other HRSRH
Programs/Clinics:
• OBIRS
• Oupatient O.T.
• Pool Therapy
• Stroke Re-check Clinic
• Dr. Clarke
Outpatient Neuro. Physio
Future Direction of Clinic:
• Geriatric Day Hospital
• Vestibular Rehab. Clinic
Outpatient Neuro. Physio
• Questions?
Hôpital régional de Sudbury Regional Hospital
2010 Outpatient Vascular
Summit
Medical Imaging
Thursday, September 15, 2010
Medical Imaging
Medical Imaging supports
outpatient clinics in three ways.
1. Outpatient Testing and Diagnosis
2. Therapeutic vascular interventions
3. IHF ownership and physician
partnership
Service Description
Relevant Outpatient Services include
• General Radiology and fluoroscopy
• All angiographic and interventional special
procedures except cardiac angiography
• CT scanning (Dual side by Side 64 slice)
capable of arterial/venous angiography via
venous injections.
• MRI scanning (Single 16 channel) capable of
arterial/venous angiography via venous
injections
• Ultrasound arterial and venous assessments
Service Description
North Tower (Located on the 2nd floor, north of the OR’s and
the ER)
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This Primary Inpatient or Outpatient therapeutic interventions
department includes
3 Digital radiology rooms
1 Inpatient fluoroscopy room
3 Ultrasound suites
2 64slice CT scanners
1 MRI
2 Digital Angiography suites
24/7 Technical Area
6 Bed recovery area
Outpatient Interventional Preadmission Suite
Reception and Registration
Stretcher holding capacity separate from patient waiting.
North Tower Hours of Operation
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NT General Radiology will be staffed 24 hours a day; 7 days a week
with booked examinations and procedures 8 hours a day, 5 days a
week (M-F).
NT General Radiology ER Suite is staffed 24 hours a day; 7 days a week
with backup support and trauma pager coverage.
NT Angiography Services will be offered 8 hours per day (0800-1600),
5 days per week. Call services are available 24/7.
NT Ultrasound will book examinations 14 hours a day, 5 days per week
(M-F)(0700-2100). Saturdays and Sundays 9 hours (0800-1700).
CT and MRI services will be offered as per today’s standards provided
that MOH Wait time funding is maintained. Call will be offered 24/7 for
ER and specialist emergencies.
CT North Tower operational 17 hours per day (M-F) (0700-2400) plus
call 24/7. Saturday-Sunday 8 hours (0730-1530).
MRI North Tower operational 16 hours per day, 7 days a week. (07002300) plus call.
Service Description
South Tower (Located on the 2nd floor, adjacent to ACU)
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This Primary Outpatient department will include;
2 Digital radiology rooms
2 Conventional radiology rooms with CR
1 Digital outpatient fluoroscopy room
4 ultrasound Suites
2 Digital mammography rooms
1 Digital Prone Stereotactic Biopsy table
Central Bookings
Reception and Registration
File Room
Administration
South Tower Hours of Operation
• Important Note: The South tower designed as an outpatient
center, was never planned to accommodate Inpatients and does
not have the capacity to accommodate Inpatients. As a result,
upon consolidation, all inpatient services with the exception of
Nuclear medicine will be performed in the North Tower. The
only planned exceptions will be ERCP patients who will be
serviced in the South Tower Fluoroscopy room.
• ST General Radiology will be staffed 10 hours per day, Monday
to Friday (700-1700).
• ST Ultrasound will book examinations 10 hours a day, 5 days
per week (M-F). (0700-1700)
• ST Mammography will be offered 10 hours per day, Monday to
Friday (0700-1700).
• ST Nuclear Medicine will be offered 10 hours per day, Monday
to Friday. (0700-1700).
Sudbury Vascular Lab
• Outpatient Vascular Ultrasound
clinic run in conjunction with VINO
(Vascular Institute of Northern
Ontario).
Questions?
Hôpital régional de Sudbury Regional Hospital
Outpatient
Vascular Summit
Tobacco Dependence
Treatment Initiative
September 16th, 2010
Tobacco Dependence Treatment Initiative
• Expansion site for Ottawa Model-UOHI
• Advisory Committee formed, Coordinator
hired-policies, tools created, best
practices examined, limited
implementation of Ottawa Model begins
in 2007
• Additional funding-2009-2011 through
Federal Tobacco Strategy-Regional
Expansion; partnership with three other
hospitals
• Currently housed under Preventive
Oncology & Screening Division-RCP
Tobacco Dependence Treatment Initiative
Patient Population:
• Initial pilot began on vascular, thoracic and
urology surgical unit-baseline tobacco use
prevalence rate is 37% (used tobacco in last 6
months)
• Expansion to Cardiology unit-baseline tobacco
use prevalence rate is 22%
• 68% prevalence rate-inpatient psychiatric unit
Nurse hired to develop in-patient policy and
procedures for this specialized population
• Some outpatient clinics-CCS Fax Referral
Program
Tobacco Dependence Treatment Initiative
Current Patient Volumes
• Under FTS Grant Baseline patient
enrolment 144-November2009-February
2010 (patients given usual care)
• Intervention group February 2010September 10- (196 patients counselled
and given option of IVR follow-up)
• NRT available hospital wide through preprinted order
Tobacco Dependence Treatment Initiative
Patient Journey:
• Upon identification of patient as having used
tobacco within last six months, hospital-wide
pre-printed order is used to initiate provision of
NRT. Training re NRT guidelines for front line
staff is currently being held.
• On units where Nurse Counsellor provides
service, patient is visited, consultation form
filled out, counselling provided, NRT prescribed,
post discharge support offered in form of
Interactive Voice Response and referral to
available community resources.
Tobacco Dependence Treatment Initiative
Internal and external partnerships
• Psychiatric Inpatient unit
• Fax Referral program (Stroke Program, DECP,
RCP, Cardiac Pulmonary Rehab)
• FTS Regional Partnership- 3 hospitals
• OHSS Tobacco Cessation Program
• Aboriginal & Francophone groups
• TCAN and Cessation sub committee
• UOHI
• TEACH-CAMH
• June 2009 Regional Conference
Tobacco Dependence Treatment Initiative
Future Directions
• Introduction of smoke free grounds-July
2010-Staff, volunteers, students,
contractors
• Patient ban to follow with additional
smoking cessation support (possibly
early 2011)
• Expansion of Fax Referral Program to
additional outpatient units
• Exploring sustainable funding
Tobacco Dependence Treatment Initiative
Future Directions cont’d…
• HRSRH Board is establishing a
quality indicator related to smoking
cessation. Need to establish a
consistent systematic, mandatory
mechanism for recording the
smoking status of all patients
admitted to HRSRH
Hôpital régional de Sudbury Regional Hospital
Outpatient
Vascular Summit
OBIRS
September 16th, 2010
OBIRS (Outpatient Brain Injury Rehab Service)
• Established in 1990, part of the Rehabilitation &
Transitions Program
• An adult (16+) out-patient program specializing
in post-acute rehab services for individuals with
a confirmed diagnosis of brain injury.
• An Interdisciplinary team which provides
assessment and rehabilitation therapy to assist
the client in returning to their identified roles at
home and in the community.
OBIRS-Interdisciplinary Team
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Social Worker
Speech and Language Pathologist
Occupational Therapist
Psychological Associate
Recreation Therapist
Case Manager
Program Secretary
OBIRS: Admission Criteria
Individuals must have a documented, established
diagnosis of an Acquired Brain Injury defined
as:
• Occurs at least 7 days after birth and is not
related to a congenital disorder or
developmental disability, (e.g., cerebral palsy,
muscular dystrophy, autism, spina bifida) or a
process which progressively damages the brain,
(e.g., dementing processes, MS, Alzheimer’s
Disease, Parkinson’s Disease)
OBIRS: Admission Criteria
• Damage to the brain caused traumatically e.g.,
from an external force such as collision, fall, or
assault
• Damage to the brain caused through a medical
problem or disease process which causes
damage to the brain e.g. anoxia, nonprogressive tumour, aneurysm, infection, stroke
with diffuse cognitive deficits
OBIRS: Participate to Learn
• A Rehab approach which aims to reduce the
client’s need to generalize the strategies
being learned to their ‘real life’ situations.
• Therapy is conducted within the home,
workplace, on-site or in the most relevant
community setting. This requires more active
involvement of the client and their support
system and increases the likelihood carryover and longer-term success.
• “Roles as Goals”---Goals should be developed
jointly and be meaningful to the client and
their families.
OBIRS: Referral Source
36%
64%
IRU Inpatient
Transfers (N= 29)
Outpatient Referrals
(N=52)
OBIRS: Referral Distribution
Region 26%
Sudbury/Manitoulin
74%
Sudbury/Manitoulin 74%
North East Region 26%
OBIRS 2009/10 Referral Pattern
60
50
40
30
20
10
0
Sudbury
Manitoulin
North Bay
Parry Sound
Elliott Lake/Blind River
Espanola/Birch Island
Kirkland Lake
Temiskaming
Sault Ste Marie
Wawa
Timmins
OBIRS Wait list Management
A Priority system based on the following:
I.
II.
III.
IV.
Individuals preparing for discharge from an
inpatient program with a primary diagnosis of ABI
Individuals identified through ABI Case
Management
Individuals less than 3 years post-injury at the
time of the referral
All other referrals are prioritized according to date
received.
OBIRS Referral/Rehab Pathway
ABI referral received
Reviewed and
Placed on wait list
Intake Assessment
Interdisciplinary Team Assessment
& Review (as needed)
Referrals to other
Services as
appropriate
Feedback to client & referral sources
and Individualized Goal development
Pre-testing
Active Rehabilitation (group, individual
Community based) (Length of stay varies)
Case Conference review 6-8 weeks
Discharge & Post-testing
Case Management Follow-up up to 1 year
Family
Involvement
OBIRS: Alternate Pathway
• If a client already has clearly defined deficits
and treatment needs (i.e. already assessed
elsewhere) they may move directly into active
treatment
• Clients being transferred from an inpatient
acquired brain injury program move directly
into active treatment
OBIRS: Outreach Consultation
• Regional clients may be assessed in-person
with the assistance of Health Travel Grants, by
the Ontario Telehealth Network or in their home
communities by 1-2 members of the
Interdisciplinary team
• Assessment results and recommendations are
provided to local services for implementation
and follow-up
• Some clients may obtain ongoing treatment
using OTN or direct travel to Sudbury if
preferred.
OBIRS: Current Relationships
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ABI FLIC team/ABI Service Continuum
Out-patient Neuro Physiotherapy
Stroke Re-check clinic
Cardiac Rehab Service (Rec Therapist)
Mental Health & Addictions (SUBI,
Bridging)
Neurology
Forward to Function (Chronic Pain, WSIB)
Trauma Services
Driving Assessment Service
Cancer Program
OBIRS: Future Relationships?
• Trauma Team (Concussion Clinic)
• Geriatric/Adult Day Hospital
• Children’s treatment Center (adolescent
transition)
• Strengthened relationship with
Psychiatry/Mental Health & Addictions
• Strengthened relationships with Cancer
Program
• Professional Practice/NOSM/Laurentian
• Education and Awareness of ABI across
organization
OBIRS: External Relationships
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Ontario March of Dimes
Ontario Brain Injury Association
Toronto Rehab & ABI Network
Neurotrauma Foundation
CHIRS/CAMH
Case Management companies/WSIB/Insurance
Companies
• North-eastern Ontario ABI Network
• Academic Affiliations
Hôpital régional de Sudbury Regional Hospital
Outpatient
Vascular Summit
A.C.U. Vascular Clinic
September 16th, 2010
A.C.U. Vascular Clinic
History of clinic:
• Introduced in 2007
• Initially to see 6-8 vascular patients
• Currently 18-25 vascular/complex
wounds per week
• Falls within A.C.S. / D.S.A.C.P.
A.C.U. Vascular Clinic
Patient Population:
• Quantitative data not collected
• Complex wound patients related to
diabetic ulcer
venous ulcer
post-op amputations
other (some skin cancers discovered)
A.C.U. Vascular Clinic
Annual Visits
2008-09………………… 753
2009-10………………….779
A.C.U. Vascular Clinic
Current Patient Volumes
Weekly clinics 18– 25 patients
Year to Date: April - August
2006
2007
2008
2009
2010
121
219
279
319
345
A.C.U. Vascular Clinic
Patient Journey:
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Patient referred to a vascular surgeon
Initial booking by surgeon’s office
Regular visits as required
Patients seen by:
- Vascular surgeon
- Enterostomal Therapy Nurse
- A.C.U. Nursing Staff
- Medical Photographer
A.C.U. Vascular Clinic
Future Direction of Clinic
Potential – O.D.S./ MOHLTC call for
proposal: Centre for Complex
Diabetes Care
• Possible linkages between A.C.U.,
CCDC, Bayshore outpatient clinic
A.C.U. Vascular Clinic
• Growing need clearly demonstrated
• NECCAC also looking at processes
re: Diabetic Foot & venous leg
ulcers
• Experiencing difficulty containing
vascular clinic within allocated
resources.
A.C.U. Vascular Clinic
Thank You
Hôpital régional de Sudbury Regional Hospital
Outpatient
Vascular Summit
Outpatient Rehabilitation
Presentation
September 16th, 2010
Outpatient Rehabilitation
Services:
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Chiropody
Augmentative Communication Clinic
Prosthetics and Orthotics
Seating Clinic
Outpatient Physiotherapy
Outpatient Occupational Therapy
Driver Assessment and Rehabilitation Service
Helpline Personal Emergency Response Service
Outpatient Rehabilitation
Patient Population:
• Adult (over 18 years)
• Varies by service; includes Stroke, acquired
brain injury, diabetes, dementia, multi-trauma
etc.
• Physician referral required (internal, external)
• Self referral (Helpline)
Outpatient Rehabilitation
Current Patient Volumes
• High referral volumes for some, not all
services
• Prioritization of referrals by service team
• Wait times variable by service and
priority of need
Outpatient Rehabilitation
Patient Journey:
• Upon receipt of physician referral, service lead
reviews and assigns priority
• pt contacted with appointment by rehab
reception staff
• Initial visit – assessment by involved staff
(dependent on service – OT, PT, Chiropodist,
Orthotist, etc.)
• Treatment provided (can include hands-on tx,
fabrication of necessary device, education)
• Discharge (follow-up available dependent on
service)
Outpatient Rehabilitation
Relationships Established with other
HRSRH Programs/Clinics
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Inpatient units / IRU
Medical / Surgical units (ex. outpt physio)
Transitional Care Unit (ex. Chiropody)
Children’s Treatment Centre (P&O)
Outpatient Rehabilitation
Future Direction of
Clinic/Program
(Definite and Possible)
• Geriatric and Adult Day Hospital
– Linkage of existing outpt PT / OT
• DARS – Driveable centre
• Use of new technology to realize improved
efficiencies (ex. P&O)
Hôpital régional de Sudbury Regional Hospital
Outpatient
Vascular Summit
Geriatric and Adult Rehab
Day Hospital (GARD)
September 16th, 2010
Geriatric and Adult Rehab Day Hospital
History:
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ALC Task Force
Specialized Geriatric Services Committee
Location – first floor north tower
Program Development
Geriatric and Adult Rehab Day Hospital
Mandate:
• To provide comprehensive multidisciplinary assessment
and rehabilitation in order to help individuals maintain or
improve their level of function.
• The goal is to facilitate optimal independence and quality
of health so that they can remain at home as long as
possible
• Short-term treatment, counseling, and education are
available to patients and their caregivers to facilitate
community support and long-term care planning.
• The service is designed as an alternative to admission to
hospital or to facilitate discharge and decrease current
length of stay required by current in-patients.
Geriatric and Adult Rehab Day Hospital
The multidisciplinary team includes:
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Occupational Therapist
Social Worker
Speech-Language Pathologist
Physiotherapist
Nurse
Clinical Nurse Specialist
Dietitian
Pharmacist
The individual’s family physician will manage the
individual’s medical needs.
• Consultation with a Geriatrician or Physiatrist may be
arranged as needed
Geriatric and Adult Rehab Day Hospital
Services Provided:
• Coordination of healthcare services and community
resources
• Health education
• Links with social and leisure activities
• Maximization of mobility and improved physical wellness
• Assessment of cognitive abilities
• Assistance with depression and anxiety issues
• Home safety
• Hydrotherapy
• Caregiver stress
• Communication difficulties and swallowing issues
• Nutrition and weight loss
• Medication review, monitoring and counseling
Geriatric and Adult Rehab Day Hospital
Patient Population:
• Must require a comprehensive multidisciplinary approach to
rehabilitation to attain maximum functional independence.
• Must be 65 years of age or older for the Geriatric stream and
18 of age or older for the Adult stream.
• Must be a resident of the Sudbury Region.
• Must be medically and psychiatrically stable and be able to
tolerate travel to and from the program in addition to the
therapy provided.
• Must be willing and able to engage at a purposeful level and be
sufficiently oriented to their surroundings.
• Must have the potential to achieve realistic and self-directed
goals.
• A tolerance level to attend on average two-and-a –half hour
session twice a week for 6 to 8 weeks is required.
Geriatric and Adult Rehab Day Hospital
Current Activity
• Referral Process
• Intake process
• Metrics
• First patient activity
– SLP
– Dietitian
Geriatric and Adult Rehab Day Hospital
Relationships:
• GEM
• In-patient units
• NE RGP
• NECCAC
• Community Supports
Geriatric and Adult Rehab Day Hospital
Future Direction:
• Out patient OT
• Outpatient PT
• Stroke Re-Check
• Value added services