Here, Dr. Gurneet Singh Sawhney gives SR Times insight into the stroke pathway at Clinic Spots.
Dr. Gurneet Sing Sawhney, is a neurosurgeon with 18+ years of experience in the field and has expertise in different fields of procedure surgeries like complex neurosurgical and neurotrauma procedure.
Overview of the stroke pathway
A stroke pathway is a task-oriented structured multidisciplinary care plan that details essential steps and interventions during the period of care of a stroke patient.
Our stroke pathway consists of a paper document that contains general advice about acute stroke management and daily activities for each of the first five days of admission.
We provide interventions such as thrombolysis, endovascular thrombectomy, antithrombotic treatment, blood pressure management, dysphagia screening, and secondary prevention according to the latest guidelines and evidence.
We also provide rehabilitation services such as physiotherapy, occupational therapy, speech therapy, and neuropsychology to help patients recover their function and quality of life.
Unique features of our approach
We have a dedicated stroke team that includes neurologists, nurses, radiologists, interventional neuroradiologists, pharmacists, therapists, and social workers who work collaboratively to provide comprehensive and coordinated care for stroke patients.
We use a standardised stroke scale (NIHSS) to assess the severity and prognosis of stroke and to monitor the response to treatment.
We have a rapid access stroke clinic that allows patients with transient ischemic attack (TIA) or minor stroke to be assessed and treated within 24 hours of symptom onset.
We have a telestroke service that enables remote consultation and evaluation of stroke patients in rural or underserved areas.
Barriers and challenges to optimal outcomes
Some of the barriers and challenges we face in delivering the best possible patient outcomes are:
- Limited availability of resources such as beds, staff, equipment, and medications
- Delays in recognition and referral of stroke symptoms by patients or bystanders
- Variations in quality and accessibility of stroke care across different regions and settings
- Lack of awareness and adherence to stroke prevention strategies among patients and the general public
Some of the measures we are taking to address these barriers and/or to continually improve as a service are:
- Implementing quality improvement initiatives such as audits, feedback, education, and protocols to monitor and enhance our performance and adherence to best practices
- Participating in research and innovation projects to evaluate new technologies, therapies, and models of care for stroke
- Collaborating with other stakeholders such as primary care providers, emergency services, community organisations, and patient groups to improve the coordination and integration of stroke care along the continuum
- Engaging in advocacy and awareness campaigns to promote stroke prevention and recognition among the public and policymakers
- Team composition and skillset
- To treat stroke patients, we use medical interventions such as thrombolysis or endovascular thrombectomy
- Nurses who provide bedside care, monitoring, education, and support for stroke patients and their families
- Radiologists who perform imaging tests such as CT scan or MRI to confirm the diagnosis and location of stroke
- Interventional neuroradiologists who perform endovascular procedures such as mechanical thrombectomy or angioplasty to restore blood flow in blocked arteries
- Pharmacists who manage the medication therapy for stroke patients such as antithrombotics or antihypertensives
- Therapists who provide rehabilitation services such as physiotherapy, occupational therapy, speech therapy, or neuropsychology to help patients regain their function and independence
- Social workers who assist patients with discharge planning, community resources, financial issues, or psychosocial support
- Our skillset has changed in recent years due to the advances in stroke care such as new evidence-based guidelines, novel therapies, and emerging technologies. We have adapted our practice accordingly by updating our knowledge, skills, and competencies through continuous education and training.
Approach to families and loved ones
Harnessing support for the benefit of patients/clients by involving them in the care process, providing them with information and education, encouraging them to participate in rehabilitation activities, and facilitating their communication with the healthcare team
Supporting them through the difficult period after a stroke by acknowledging their emotions and concerns, offering them counseling or referral to support groups, addressing their needs and expectations, and empowering them to cope with the changes
Demand for service
With stroke rates rising due to factors such as the aging population, lifestyle changes, or comorbidities, we are experiencing growing demand for our service.
To meet this demand, we are taking steps such as expanding our capacity by increasing our staff numbers or beds availability; optimising our efficiency by reducing delays or waste; enhancing our accessibility by using telemedicine or outreach programs; prioritising our resources by triaging or stratifying patients according to their needs or risks.
Patient-centredness is a term that means putting the patient at the centre of everything we do as a stroke care service. It means respecting their preferences, values, goals, and experiences; understanding their context, background, culture, and beliefs; engaging them in shared decision-making; providing them with personalised care; ensuring their safety; measuring their outcomes; improving their satisfaction; partnering with them in quality improvement.
We embrace patient-centeredness as a core value of our service by adopting various strategies such as using patient-reported outcome measures (PROMs) or patient-reported experience measures (PREMs) to assess our performance from the patient’s perspective; implementing patient feedback mechanisms such as surveys or complaints; involving patients in co-designing or co-producing our services; fostering a culture of patient-centred care among our staff through education or recognition.
Use of technology
Improves our diagnosis by using advanced imaging modalities such as perfusion CT or diffusion-weighted MRI that can provide more detailed information about the extent and location of ischaemia
Enhance our treatment by using innovative devices such as stent retrievers or aspiration catheters that can achieve higher rates of recanalisation
Expand our reach by using telestroke systems that can facilitate remote consultation or evaluation of stroke patients in rural or underserved areas
Support our rehabilitation by using digital tools such as apps or games that can motivate patients to practice their skills or monitor their progress
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