Abstract TP364: Importance of Collaboration of Hospital Leaders in Implementing Stroke Best Practice Across 17 Organizations

Background: Literature indicates that organized acute stroke care and early access to intense rehabilitation improves patient outcomes. Toronto-wide system data demonstrated 1) Institutional variation in acute and rehabilitation stroke care performance 2) Specialized acute stroke centres perform better for mortality, readmission rates, time to rehab referral, and length of stay 3) Patients could be better streamed to appropriate rehab settings (18% of inpatient referrals were mild stroke; 3% of strokes referred to outpatient) 4) Need for higher intensity rehab post severe stroke to improve outcomes. Purpose: To re-organize the stroke system in a large city (Toronto) to increase access to acute stroke units and timely, appropriate rehabilitation while reducing variability in care. Methods: Recommendations generated from the above needs were endorsed by regional funders and organization CEOs. Key system decision-makers were engaged in planning and implementation through regional task groups. Organization-specific gap analyses and implementation plans were developed based on best practice and system needs. An evaluation framework, including targets, was created. Results: All 17 Toronto acute and rehab organizations committed in writing to a common vision of stroke care: o Reorganization of acute care to hospitals with geographical stroke units and dedicated interprofessional teams supporting evidence-based processes. o Early access to high intensity inpatient (3 hours therapy/patient/day within 5-7 days of stroke onset) and outpatient rehab (within 2 weeks of acute discharge). Organizational implementation plans are in progress. Working groups were established to address emerging system issues (e.g. Emergency walk-in patients). Conclusion: Key enablers crucial to the success of this transformational system change include: engagement of key stakeholders/leaders, grounding in best practices, based on a system perspective, supported by data, and funder endorsement. Regular monitoring and status reporting provides a foundation for ongoing continuous quality improvement and accountability. A knowledge translation strategy is being developed to support implementation.