New Stroke Prevention Clinic for Niagara
- March 2002
Chris Curry, Vascular Technologist and Sue Dolan, NHS Regional Stroke Care Co-ordinator with patient Ian Donaldson, in the new Stroke Prevention Clinic
To help combat the increasing number of strokes experienced by people across the Region, the Niagara Health System (NHS) has opened a Stroke Prevention Clinic, the first of its kind in the peninsula.
In February, the Allied Health Centre, located behind Greater Niagara General Site in Niagara Falls, became home to the region's first formalized Stroke Prevention Clinic. Registered Nurse Sue Dolan has been busy organizing the clinic with neurologist Dr. Donald Chew.
"Dr. Chew has been advocating for a stroke prevention clinic for quite some time, and it is exciting to develop something with him that is really going to make a difference," said Sue.
What is a stroke?
A stroke takes place when clots are released either from within the brain, blood vessels, or arterial walls. The clots travel upward, preventing the adequate flow of blood to an area of the brain.
Often, the clots become temporarily lodged and then break free, causing TIA or Transient Ischemic Attack. These transient attacks, or mini-strokes, have the following symptoms which may last a few seconds, minutes or hours before ending. They include headaches, sudden vision problems, dizziness or loss of balance, weakness in one limb or other, facial droop, difficulty with speech, numbness/tingling in fingers, or unusual memory loss. From April, 1999 to March, 2000, almost 1,000 Niagara residents were admitted to Niagara hospitals for stroke. Many more were seen and investigated for TIA.
It is this TIA group that the new Stroke Prevention Clinic will target, to hopefully prevent a full-blown stroke from taking place. Patients diagnosed with TIA at any of Niagara's seven Emergency Departments can be referred to the Stroke Prevention Clinic, with an appointment for 24 to 48 hours after the referral. Compared to the current two-month waiting time for a non-urgent TIA patient to see a Neurologist, this is fast-tracking at its best.
What can a patient expect from the Stroke Prevention Clinic?
"We plan to see two or three patients every morning from Monday to Friday." Sue explained. "First, the registered nurse will conduct a full assessment, noting any diagnostic tests that have been performed or are still required." Typically, these include laboratory work-ups as well as a CT scan (Computed Tomography – high quality digital images of the brain or other organs and tissues), and Doppler (an Ultrasound – checks the blood flow and condition of carotid arteries), but could include an:
- EEG (Electroencephalogram – uses electrodes to assess brain wave activity);
- ECG (Electrocardiogram – uses electrodes to assess heart rate & function);
- Echo (Echocardiogram – an ultrasound of the heart to assess cardiac status)
- MRI (Magnetic Resonance Imaging – highly specialized images of tissues)
The nurse will also note any other risk factors for stroke, such as high blood pressure, smoking, diabetes, heart problems, previous stroke or TIA. Following the RN's assessment, the patient will see Dr. Chew, who will conduct a neurological assessment, and order any medication and diagnostic tests still required. Some of those non-invasive tests can be carried out during the first clinic visit.
Once the data from the diagnostic tests is complete, the nurse, in consultation with Dr. Chew, will develop an individualized care plan, including necessary lifestyle changes to improve diet, cut out smoking, get more exercise, and take medications as prescribed. Any required referrals to services such as speech therapy, physiotherapy, occupational therapy or diet counselling will be organized at this time. On the patient's second visit to the clinic, their individualized care plan will be ready, and any follow-up discussion with Dr. Chew will also take place. The nurse will also provide health teaching, lifestyle modification recommendations and discuss links to community resources such as stress management, holistic care, Niagara Heart Health, Heart Niagara and Heart and Stroke Foundation programs.
"We are really trying to co-ordinate the flow of medical treatment for TIA's," Sue said. "The Stroke Prevention Clinic is one component of a plan to standardize stroke care across our region.
Earlier this year the NHS submitted a proposal to the Ministry of Health and Long Term Care to become a designated stroke centre for the peninsula. Until that approval comes, and with it up to $1 million in funding, the Stroke Prevention Clinic will go a long way to providing follow-up care for patients.
"If we are successful in being approved by the province as a Designated Stroke Centre, we can expand our teaching opportunities, open more Stroke Prevention Clinics, and expand those clinics to help 700 patients who are admitted to Niagara hospitals every year with full-blown strokes. We can also work to standardize our stroke care with the rest of the province."
Right now, Hamilton is the nearest Designated Regional Stroke Centre, and has seen a definite improvement in the health of its population by standardizing the care right from pre-hospital (ambulance) to Emergency Department, family doctors, specialists, in-hospital acute care, rehabilitation, community re-integration after hospital stay and secondary stroke prevention. Their clinics are reducing the number of people experiencing a full-blown stroke after TIA.
"We need this in Niagara, and our pilot project in Niagara Falls is a start," Susan said. "I believe very firmly that this is a step in the right direction, to improve the outcomes for patients in our community who are at risk for stroke."