[溫哥華本地新聞] Fraser Health stroke patients face including, patients, creating, prepared, Health

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Fraser Health stroke patients face ‘less than ideal’ care: report

Patients battle time delays if transferred to Vancouver for treatment
Fraser Health hospitals are diverting or transferring stroke patients to Vancouver hospitals, creating “less than ideal” care, according to an external report prepared for the provincial government.
This is despite the fact two hospitals — Royal Columbian and Surrey Memorial — are designated stroke sites and have stroke specialists — including stroke neurologists and other experts — on staff, the review found.
Rapid care is key in the treatment of stroke patients since a special class of drugs called thrombolytics may be used to break up blood clots in the brain that cause ischemic strokes. But they must be administered within 4½ hours from the onset of symptoms to be potentially effective.
So when every minute counts, those in the Fraser Health region who are transported to Vancouver hospitals instead of their nearest local facility face critical time delays, the Fraser Health Review report states.
A Fraser Health medical director downplayed the criticisms in the report on Tuesday, saying steps have been taken to address many of the concerns since the review was conducted, although he acknowledged some patients are still transferred to Vancouver.
“I can’t change what’s written there ... and it’s not a question of disputing it,” said Dr. Dave Williams, Fraser Health’s program medical director of medicine. “But we do use thrombolytics and patients are receiving the best stroke care, whether they go to Royal Columbian or Surrey.”
The Fraser Health Review, ordered by Health Minister Terry Lake last year, was released earlier this month. It flagged numerous areas of concern in the region, including adverse events suffered by patients in hospital and an over-reliance on acute care hospital beds. When it was released, Lake announced an injection of $60 million more over the next two years, on top of the $3.1 billion Fraser Health already receives from the government annually.
The report says the transfer of patients to Vancouver General Hospital from Fraser Health facilities — including Surrey Memorial — also has a negative impact on ambulance resources and patient volume at VGH.
“This is not good patient care as it introduces undue time delays to a treatment that is time sensitive. As well, it impacts (ambulance) resources and it impacts volumes at VGH,” it says.
On the issue of stroke, the report also identified these problems:
• Royal Columbian Hospital “is a designated stroke site, but their emergency (department) is resistant to accepting further volumes given their current capacity issues.”
• At Surrey Memorial, “the emergency department and neurology have not embraced or implemented the use of thrombolytics.”
Thrombolytics — specifically a drug known as tissue plasminogen activator (TPA) — were first approved for use in Canada in 1999. Since then, various advocacy organizations — including the Heart and Stroke Foundation and Canadian Stroke Network — have been agitating for greater awareness of the “time is brain” messaging, improved use of TPA and the need for designated stroke centres.
Yet the Fraser Health Review report says even hospitals designated as stroke sites — Royal Columbian, Surrey Memorial and Abbotsford Regional hospitals — are diverting or transferring stroke patients to Vancouver.
“Fraser Health has not been successful in implementing consistent use of thrombolytics in the emergency departments of designated stroke sites ... As a result, they have not been fully able to implement ambulance bypass to designated stroke sites.”
Williams said he thinks the report was based on outdated information since, in the past year, aggressive efforts have been made to improve stroke care across the region. The report looked at hospital visits in 2012/13.
He believes the report failed to consider efforts such as the hiring of new stroke neurologists, which helps hospitals like RCH provide 24/7 stroke care and consistently offer thrombolytics.

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In the case of Royal Columbian, an American stroke neurologist was hired in the past month, giving the hospital two such subspecialists in addition to five other neurologists. It plans to recruit another three, he said.

Williams didn’t deny that ambulances transport some patients to VGH from areas like Langley and Delta. He said it’s part of a historical pattern based on the fact that VGH is a centre of stroke expertise.

But Williams said that as Fraser Health builds capacity to care for such patients, they will eventually all be treated in the region in which they live.

Nearly 7,000 B.C. patients are admitted to hospitals each year with strokes, including nearly 3,000 in Fraser Health. Most of them suffered ischemic strokes as opposed to hemorrhagic.

Thrombolytic drugs are given to patients in the acute stage of an ischemic stroke after a CT scan has shown it is probably safe to do so.

Williams said only 250 Fraser Health ischemic stroke patients fit the criteria last year for receiving a thrombolytic drug, and approximately 135 such patients were transferred to VGH. He said this number will be far lower this year.

The report noted the number of “stroke neurologists “ is “very skewed toward” the western end of the Lower Mainland (Vancouver Coastal). Williams said there are more than 50 neurologists in the Vancouver area, while there are only 14 in the much bigger Fraser region.

“You do the math,” he said, referring to the fact that as the most-populated, fastest-growing part of Metro, Fraser Health has to catch up. “Yes, it is a work in progress.”

He said while there is a natural inclination to feel defensive when presented with such a hard-hitting report, “we are learning from it. We need to be more aggressive in getting patients access to TPA.”

Part of the solution lies with public education, since only a third of stroke patients get to hospital fast enough to be considered for TPA.

Dr. Devin Harris, a Kelowna emergency doctor who is medical adviser to Stroke Services BC, was one of several co-authors of the report.

He praised Fraser Health leaders such as Dr. Andrew Dawson for starting to make significant strides in the right direction. And he said patient transfers are not necessarily a bad thing; it’s always better to treat patients in a hospital with lots of experience handling strokes rather than in low-volume community hospitals lacking expertise.

Harris said Fraser Health has one of the best stroke rehabilitation programs in the province but there is still room for improvement when it comes to increasing the use of thrombolytics. Told that Williams had said most eligible patients will now be receiving the treatment, Harris said: “I would be excited, optimistic, hopeful and happy if that was the case.”

He said sometime later this year, the public will have access to a stroke report card so they can see how hospitals compare. The provincial initiative, based on data that has been collected but not yet publicly accessible, is a collaboration between the BC Patient Safety and Quality Council, Ministry of Health, Stroke Services BC and health authorities.

Hospitals will be required to measure and report the proportion of patients who die in hospital after a diagnosis of ischemic stroke. They will also have to measure and report the percentage discharged to their original place of residence, the percentage discharged to long-term care facility or nursing homes, and the proportion who received acute thrombolytic therapy.

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Fraser Health hospitals are diverting or transferring stroke patients to Vancouver hospitals, creating “less than ideal” care, according to an external report prepared for the provincial government.