Provincial Integrated Work Plans: Inventory

 

 

About the Provincial Integrated Work Plans

The annual stroke Provincial Integrated Work Plan (PIWP) process is now into its 5th cycle.  This process is intended to: 1) streamline provincial planning and project development; 2) maximize access to and use of expertise; 3) make effective use of available resources (e.g. people, funding); 4) strengthen relationships; 5) recognize existing and emerging priorities; and 6) inform and support the annual development of the provincial CorHealth work plan.  The completed PIWPs include Early Supported Discharge (ESD), A Navigation Model to Support Persons with Stroke Transitioning to the Community, the Stroke Unit Toolkit, Rehab Intensity and the Provincial Interprofessional Stroke Core Competency Framework.

About this Inventory

To support the knowledge translation, knowledge transfer and knowledge management of the PIWPs an online PIWP Inventory has been developed. This inventory includes 1) links to the PIWP work plans, final reports, deliverables, and any additional documents/tools that have been created; 2) a description of how regions across Ontario have used the various PIWPs; and 3) contact information to learn more about the work described.

 

Early Supported Discharge 

Early Supported Discharge (ESD) is defined as “a form of rehabilitation designed to accelerate the transition from hospital to home through the provision of rehabilitation therapies delivered by an interprofessional team, in the community.  It is intended as an alternative to a complete course of inpatient rehabilitation and is most suitable for patients recovering from mild to moderate stroke” (Dawson et al., 2013, p. 36)

In the Fall of 2013, ESD was identified as a provincial priority by the 11 regional stroke networks of Ontario.  To better address this priority, a Provincial Integrated Working Group was formed.  The main purpose of this working group was to support the implementation of ESD programs in Ontario.

currently there are no additional documents/tools.  If you would like more information on the resources used to support the development of this work please contact info@corhealthontario.ca

Region Description of Use Contact Name Contact Email Additional Information
Central East
  • Develop new program
  • Other

 

Donelda Sooley cesn@rvh.on.ca
info@corhealthontario.ca
  • Provincial ESD documents, including the final report and deliverables, were used to inform regional health system planners regarding the ESD model of care.
  • The information was used to develop a small pilot of ESD services. The pilot was completed and next steps are being considered by the organization and LHIN.
Northwestern Ontario  
  • Develop new program
  • Develop business case
  • Perform needs assessment
  • Other
Esmé French frenche@tbh.net

nwostroke@tbh.net
info@corhealthontario.ca

  • Provincial ESD documents used to inform regional health system planners regarding this model of care.  Deliverables supported initial discussions however have not moved beyond exploratory phase as yet.
Southeastern Ontario
  • Evaluate current programs
Stroke Network of Southeastern Ontario StrokeNetworkSEO@KGH.KARI.NET
  • Use of core elements for education and to assist regional team and Home/Community Care team in jointly identifying gaps in SE home-based community rehab program and planning changes.
Southwestern Ontario
  • Improve current program
  • Develop business case
Margo Collver margo.collver@lhsc.on.ca
info@corhealthontario.ca
  • Used information to help create a business case to submit to the Erie St. Clair LHIN. Referenced in South West Stroke Project Phase 2 when developing directional recommendations for Community Rehabilitation and Recovery.
Toronto Stroke Networks  
  • Develop new program
  • Develop business case
Beth Linkewich beth.linkewich@sunnybrook.ca
info@corhealthontario.ca
  • Literature review was used as background information to inform stroke Integrated Funding Model in-home and outpatient ESD pilot plannning and business case development. This in turn helped to inform the development of a common model for community based rehab as described by Quality-Based Procedures.  This model includes ESD, outpatient and home based rehab service provision that will support multi-LHIN planning to create a standard of community based rehab services across the LHINs.

 

 

Dawson AS, Knox J, McClure A, Foley N, and Teasell R, on behalf of the Stroke Rehabilitation Writing Group. Chapter 5: Stroke Rehabilitation.  In Lindsay MP, Gubitz G, Bayley M, and Phillips S (editors) on behalf of the Canadian Stroke Best Practices and Standards Advisory Committee.  Canadian Best Practice Recommendations for Stroke Care: 2013; Ottawa, Ontario Canada: Heart and Stroke Foundation and the Canadian Stroke Network.

 

A Navigation Model to Support Persons with Stroke Transitioning to the Community 

Transitions from  hospital to the community can be a challenging time for both the stroke survivor and family.   The Canadian Best Practice Recommendations state that “patients and families should be provided with information, support, and access to services throughout transitions to the community following a stroke to optimize the return to life roles and activities” (Cameron et al., 2016, p. 815)

In the Fall of 2013, A Navigation Model to Support Persons with Stroke Transitioning to the Community was identified as a provincial priority.  To help move this work forward a Provincial Integrated Working Group was formed.  The main objective of this group was to develop a set of resources for health service  organizations and/or teams to support and improve the processes for the transitioning the stroke survivor from inpatient care to the community.

currently there are no additional documents/tools.  If you would like more information on the resources used to support the development of this work please contact info@corhealthontario.ca

Region Description of Use Contact Name Contact Email Additional Information
Central East
  • Develop new program
  • Improve current program
  • Other

 

Alda Tee cesn@rvh.on.ca
info@corhealthontario.ca
  • Provincial documents and resources shared with navigation roles throughout the region.
  • Information used to inform development of the navigation function as part of a system re-design initiative.
Central South
  • Implement best practices
  • Develop new program
  • Improve patient outcomes
Stefan Pagliuso pagliuso@hhsc.ca
info@corhealthontario.ca
  • Central South Regional Stroke Network is currently in the developmental stages of a model for community stroke navigation within the region. The Navigation Model PIWP has provided excellent information and resource for this model development.
Northeastern Ontario  
  • Improve current program
  • Improve patient outcomes
  • Provide new hire orientation
Sue Verrilli

 

Rebecca Bowes

sverrilli@hsnsudbury.ca
rbowes@ican-cerd.com
info@corhealthontario.ca
  • The North East area is a pioneer when it comes to community navigation. We have Community Stroke Nagivators in Parry Sound, North Bay, Sault Ste Marie, Timmins, Temiskaming Shores and Sudbury. We partnered with Laurentian University School of Nursing and conducted a three year Community Reintegration Research Project which showed the value of navigation. This was published and was presented at International Stroke Conference. We aim to continue to promote the value, need and impact of COMMUNITY navigation (as opposed to system navigation) across the province. We were well into development of this program when Sue took on co-lead of PIWP. Our program helped inform the deliverables of PIWP group and also, subsequently, the final report and model from the PIWP, in turn, supported our regional program.
Northwestern Ontario
  • Develop new program
  • Improve current program
  • Evaluate current program
Keli Cristofaro cristofk@tbh.net

nwostroke@tbh.net
info@corhealthontario.ca

  • Navigation model documents used to inform community organization regarding this model of care. Deliverables supported initial discussions however have not moved beyond exploratory phase as yet. Keen interest from community organizations at this time with further discussions to commence.
Southeastern Ontario
  • Develop new program
Stroke Network of Southeastern Ontario StrokeNetworkSEO@KGH.KARI.NET
  • We are curretly exploring navigation models and approaches and the potential application here in the SE. The PIWP provides collated information on some existing programs as well as research supporting the benefits of structured navigation support.
Southwestern Ontario  
  • Implement best practices
  • Develop new program
  • Improve current program
  • Develop business case
  • Improve patient outcomes
  • Perform needs assessment
  • Provide new hire orientation
  • Evaluate current programs
  • Improve access
Margo Collver margo.collver@lhsc.on.ca
info@corhealthontario.ca
  • Used to support the creation of a joint LHSC/Parkwood Institute pilot stroke navigator position to support transitions from LHSC. Information used to create the job description and support the hiring of a community navigator in Windsor Essex. Trigger Tool from resource repository used in Community Re-Engagement workshops.
West GTA
  • Implement best practices
  • Develop business case
  • Improve patient outcomes
  • Improve access
Nicole Pageau nicole.pageau@thp.ca
info@corhealthontario.ca
  • We have had a community Stroke Navigator model for 5 years and are in the process of builidng a business case to expand throughout the WGTASN Region.

 

 

Cameron JI, O’Connell CM, on behalf of the Managing Stroke Transitions of Care Writing Group. Managing Stroke Transitions of Care Module 2015. In Lindsay MP, Gubitz G, Bayley M, and Smith EE (Editors) on behalf of the Canadian Stroke Best Practices and Advisory Committee. Canadian Stroke Best Practice Recommendations, 2015; Ottawa, Ontario Canada: Heart and Stroke Foundation

Stroke Unit Toolkit

It has been found that stroke patients whos receive care on a specialized stroke unit have an increased likelihood of survival, return to the home, and independence post stroke (Casaubon et al., 2015) .  In the Fall of 2014, a provincial integrated working group was formed to develop a stroke unit toolkit.  The aim of this toolkit was to provide organizations with a resource that would assist centres with the development and improvement of new and or existing stroke units.

 

currently there are no additional documents/tools. If you would like more information on the resources used to support the development of this work please contact info@corhealthontario.ca

Region Description of Use Contact Name Contact Email Additional Information
Central South
  • Implement  best practices
  • Develop new program
  • Develop business case
  • Perform needs assessment
  • Improve access
Stefan Pagliuso pagliuso@hhsc.ca
info@corhealthontario.ca
  • Joseph Brant Hospital is currently in the process of developing and Integrated Stroke Unit.  Joseph Brant Hospital has agreed to pilot the use of this PIWP in the development of the integrated stroke unit.
Champlain
  • Implement best practice
  • Improve current program
  • Improve patient outcomes
  • Improve access
Acute Care Coordinator acutecoord@champlainregionalstrokenetwork.org
info@corhealthontario.ca
  • Utilized as part of the Stroke Unit implementation in 2016/17 at the Ottawa Hospital (RSC).
Northeastern Ontario
  • Implement best practice
  • Develop new program
  • Develop business case
  • Improve patient outcomes
Shelley Hawton

 

Carla Dolanjski,

Susan Bursey

shelley.hawton@nbrhc.on.ca;

cdolanjski@tadh.com;

sbursey@hsnsudbury.ca
info@corhealthontario.ca

  • Timmins and District Hospital and North Bay Regional Health Centre used this as a reference when developing their new integrated stroke units in 2016-17. Health Sciences North will be using the toolkit as a “bible” when developing their new acute stroke unit in 2017. The Regional Network also referred to it when conducting a financial analysis of current state of stroke care compared to best practice state in collaboration with a consultant (Jan-Mar 2017)
Northwestern Ontario  
  • Improve current program

 

E. Edwards edwardse@tbh.net

nwostroke@tbh.net
info@corhealthontario.ca

  • The full Toolkit is not being used at this time. Our Acute and Rehab Stroke Unit are already established. Our network referred to the Stroke Unit Orientation section when redesigning the RSC Regional Stroke Unit Orientation Program.
Southeastern Ontario
  • Evaluate current programs
  • Other
Stroke Network of Southeastern Ontario StrokeNetworkSEO@KGH.KARI.NET
  • Used the Evaluation Section & Appendix F -Quality Indicators during development of Regional Dashboard; Referred site to the Stroke Unit Visit Guidelines for Site Visit; Used sections to support sites with sustaining Stroke Units & Care (e.g., ASU Bed Formula, Orientation and Stroke Expertise Sections); Will use toolkit when planning Integrated Unit.
Southwestern Ontario
  • Implement best practices
  • Develop new program
  • Improve current program
  • Develop business case
  • Improve patient outcomes
  • Improve access
Gina Tomaszewski gina.tomaszewski@lhsc.on.ca
info@corhealthontario.ca
  • The toolkit was used as a resource in the development of integrated stroke units in the region. Stroke Unit Contact List was helpful in locating Telestroke sites of similar size. Site Visit Questionnaire was used for several visits.
West GTA
  • Improve patient outcomes
  • To evaluate current programs
  • Improve access
Nicole Pageau

 

nicole.pageau@thp.ca
info@corhealthontario.ca
  • The Stroke Unit Toolkit was shared with Halton Healthcare to compliment their implementation of their Acute Stroke Unit. It was also shared with William Osler to enable them to implement a Stroke Unit at both their sites.

 

 

 

Casaubon LK, Boulanger JM, on behalf of the Acute Inpatient Stroke Care Writing Group. Acute Inpatient Stroke Care Module 2015. In Lindsay MP, Gubitz G, Bayley M, and Smith EE (Editors) on behalf of the Canadian Stroke Best Practices and Advisory Committee. Canadian Stroke Best Practice Recommendations, 2015; Ottawa, Ontario Canada: Heart and Stroke Foundation.

Rehabilitation Intensity

Quality-Based Procedures (QBP) for stroke state that “stroke patients should receive, via an individualized treatment plan, at least 3 hours of direct task-specific therapy per day by the interprofessional stroke team for at least 6 days per week” ( Health Quality Ontario & Ministry of Health Long-Term Care, 2016 and p. 75)

In the Fall of 2014, a provincial integrated working group was formed to support rehabilitation programs and integrated stroke units across Ontario with the provision of greater rehab intensity and a standardized approach to collecting rehab intensity data.

  1. Resource guide to support the measurement of rehabilitation intensity in in-patient stroke rehab (February 2015) 
  2. Stroke Rehab Intensity FAQ (Revised November 2017)
  3. Presentation: Every Minute Counts- Stroke Rehab Intensity (February 2015) 
  4. Provincial slide deck to support rehabilitation intensity data collection by front line staff (February 2015)
  5. Development of an OSN rehabilitation intensity communique (2015)
  6. Development and implementation of 3 OTN videoconference/webcast education sessions:
  7. Development of rehab intensity newsletters: July 2015 edition and December 2015 edition
  8. Development of stroke rehabilitation intensity pocket cards (Revised September 2017)
  9. Literature Review:
  10. Development of a whiteboard video on rehabilitation intensity (January 2016) 
  11. Survey to evaluate resource needs to support implementation of rehab intensity data collection- Stroke Congress Poster ( September 2015)
Region Description of Use Contact Name Contact Email Additional Information
Central East
  • Implement best practices
  • Improve current program
  • Perform needs assessment
Donelda Sooley cesn@rvh.on.ca
info@corhealthontario.ca
  • Educational and implementation resources including webinars, communiques, pocket cards, etc. were disseminated to support knowledge translation and implementation of Rehabilitation Time data collection.
  • Rehab Coordinator met with teams at each of the 10 inpatient rehabilitation facilities in the region to have initial dialogue, increase understanding, understand barriers and current practices and brainstorm opportunities.
  • The 10 inpatient rehabilitation facilities were brought back together for a regional forum on Rehabilitation Intensity which included a rehab expert speaker, implementation examples from other organizations, and Quality Improvement methodologies led by Health Quality Ontario.
  • Ongoing support for improvement of rehabilitation intensity has been offered; ongoing feedback regarding current status has been delivered.
Central South
  • Implement best practices
  • Improve current programs
  • Improve patient outcomes
  • Evaluate current programs
Darlene Venditti venditti@hhsc.ca
info@corhealthontario.ca
  • Central South has undergone region wide implementation of QI initiatives related to data capture and optimization of rehabilitation intensity.  Specific QI initiatives vary from site to site.
Champlain
  • Implement best practices
  • Improve current program
  • Improve patient outcomes
  • Perform needs assessment
  • To evaluate current programs
Rehab Coordinator rehabcoord@champlainregionalstrokenetwork.org
info@corhealthontario.ca
  • Initially we used communiques, pocket card, slide decks etc. to support KT on RI in region. The attention given to RI by the PIWP and RC groups encouraged Champlain to complete a region-wide QI project on increasing RI at our 6 hospitals that deliver stroke rehab (2015/16). In 2016/17 most hospitals sustained the RI QI culture. RI for 6 hospitals is monitored quarterly by a stroke rehab sub-committee..
Northeastern Ontario
  • Implement best practices
  • Develop business case
  • Improve patient outcomes
Jenn Fearn jfearn@hsnsudbury.ca
info@corhealthontario.ca
  • When our Regional Network conducted a financial analysis of current state of stroke care compared to best practice state in collaboration with a consultant (Jan-Mar 2017) the rehab intensity principles were applied.
  • Similarly in Timmins and North Bay, rehab intensity principles were taken into consideration with the development of their integrated stroke units.
  • With the development of the acute stroke unit at Health Sciences North, the rehab intensity resources were used to educate the staff on the principles of rehab intensity as they will be providing weekend coverage on the intensive rehab unit
Northwestern Ontario
  • Implement best practices
  • Improve current program
  • Improve patient outcomes
  • Provide new hire orientation
  • Evaluate current programs

 

Esmé French frenche@tbh.net

nwostroke@tbh.net
info@corhealthontario.ca

  • The deliverables have been invaluable in educating administrators and clinicians when RI data collection was made mandatory. Ongoing webinars, FAQ documents and Communiques support continued ongoing staff education, quality improvement initiatives and program evaluation.
Southeastern Ontario
  • Implement best practices
  • Evaluate current programs

 

Stroke Network of Southeastern Ontario StrokeNetworkSEO@KGH.KARI.NET
  • Educational resources/webinars were used by RC and sites across region to support their implementation of Rehabilitation Time data collection.  As materials were released throughout the PIWP cycle they were used to support the process as it was timely to the launch of the new data measure.  The PIWP group responded to feedback throughout the development and adjusted the resources available.
Southwestern Ontario
  • Implement best practices
  • Improve current program
  • Improve patient outcomes
  • Evaluate current programs
  • Other
Lyndsey Butler lyndsey.butler@lhsc.on.ca
info@corhealthontario.ca
  • Used the PIWP to support education, resulting in strategies to implement rehabilitation intensity and improve patient outcomes ( i.e., A region-wide Rehabilitation Intensity Forum took place in 2015, dissemination of OSN communiques on Rehabilitation Intensity, promotion and attendance at webinars and stroke rounds on rehabilitation intensity, and promotion of QBP Resource Centre on Rehabilitation Intensity).
Toronto Stroke Networks
  • Implement best practices
  • Improve current program
  • Improve patient outcomes
Sylvia Quant sylvia.quant@sunnybrook.ca
info@corhealthontario.ca
  • To support stroke best practices, improve data quality and enhance rehab intensity (RI) provision within the TSNs’ rehab sites (Bridgepoint Sinai Health System, Providence Healthcare, Scarborough and Rouge Hospital-Centenery Site, St. John’s Rehab, Toronto Rehab, West Park Healthcare Centre). The Toronto Stroke Networks (TSNs) have been using the RI PIWP deliverables (standard education, resources and RI calculations) to inform and support local planning with respect to the provision of rehab intensity, RI data collection/reporting, staff education.
  • Leveraging the RI PIWP deliverables has led to the development of standard approaches in collecting and reporting RI amongst rehab sites within the TSNs, standard RI data quality indicator definitions, and a novel quality assurance framework that has been used by sites to support quality improvement.   Rehab sites have developed RI internal reports and reporting processes to provide feedback to staff to improve RI data quality.  RI PIWP education and resources have been used by rehab sites to support staff orientation and ongoing education.
West GTA
  • Implement best practices
  • Improve current program
  • Improve patient outcomes
  • Improve access
Janine Theben Janine.Theben@THP.ca
info@corhealthontario.ca
  • The Rehab Intensity PIWP information has been shared with all our regional partners. Still in initial phase of KT.

 

 

Health Quality Ontario; Ministry of Health and Long-Term Care. Quality-based procedures: clinical handbook for stroke (acute and postacute). Toronto: Health Quality Ontario; 2016 December. 132 p. Available from: http://www.hqontario.ca/evidence/evidence-process/episodes-of-care#community-stroke.

 

Provincial Interprofessional Stroke Core Competency Framework

The Canadian Best Practice Recommendations state that “the core interprofessional team on the stroke unit should consist of healthcare professionals with stroke expertise” (Casaubon et al., 2015, p.243)

In Fall of 2014, a provincial working group was formed to develop a comprehensive Provincial Interprofessional Stroke Core Competency Framework.  The purpose of this framework would be to provide health care professionals, working in stroke care, with a comprehensive way to achieve the core competencies needed for evidence based stroke care.

Core Competency Communique (2017)

If you would like more information on the resources used to support the development of this work please contact info@corhealthontario.ca

Region Description of Use Contact Name Contact Email Additional Information
Central East  
  • Implement best practices
  • Develop new program
  • Improve patient outcomes
  • Perform needs assessment
  • Provide new hire orientation
  • Evaluate current programs
  • Other
Dorothy Burridge cesn@rvh.on.ca
info@corhealthontario.ca
  • Variable uptake across the region
  • Overview provided to 4 district hospitals
  • Best Practice Skills day for Region held Feb 21, 2017
  • Sites starting to use framework as a tool to identify gaps in stroke education and as a base for new staff orientation
Central South
  • Implement best practices
  • Improve current program
  • Improve patient outcomes
  • Provide new hire orientation
Barb Kubilius kubilius@hhsc.ca
info@corhealthontario.ca
  • Multiple sites in Central South utilized the toolkit as part of the pilot.  The pilot is now complete
Champlain
  • Implement best practices
  • Improve current program
  • Improve patient outcomes
  • Perform needs assessment
Education Coordinator educoord@champlainregionalstrokenetwork.org

info@corhealthontario.ca

  • Sites have suggested that the competencies will be used for orientation of new staff and students, for performance appraisals and goal setting, for review of best practices, and as a standard for accreditation
Northeastern Ontario
  • Implement best practices
  • Develop new program
  • Improve current program
  • Provide new hire orientation

 

Susan Bursey

 

Sue Verrilli

Shannon Stack

sbursey@hsnsudbury.ca;

 

sverrilli@hsnsudbury.ca;

 

shannon.stack@nbrhc.on.ca;

info@corhealthontario.ca

  • When their ISU was forming, North Bay Regional Health Centre used the Nursing core competencies to educate nurses. The Framework will be used Summer/Fall 2017 at Health Sciences North (HSN) to support the training and orientation of a new 7 day-a-week allied health stroke team (a pilot project). To support that project, a tool was created for the team to record how much time they spent on the rating scale and each of the 16 competencies.  An expectation that the Framework be completed in one year of employment has been added to the job postings for PT, OT, SLP working in stroke care at HSN.  Each DSC in our region will promote the use of the framework.  Our region has fairly new designated stroke RNs so the nursing competencies will be of support in their ongoing learning.
Northwestern Ontario
  • Perform needs assessment
  • Other

 

Keli Cristofaro cristofk@tbh.net

nwostroke@tbh.net
info@corhealthontario.ca

  • Participated in Pilot Phase in 2016. Core Competencies documents will be used to support initial discussions however leadership meeting has not been confirmed to date. To have further discussions with Regional Stroke Unit and Rehab Unit managers re: usability.
Southeastern Ontario
  • Implement best practices
  • Improve current program
  • Perform needs assessment
  • Provide new hire orientation
  • Evaluate current programs
  • Other
Stroke Network of Southeastern Ontario StrokeNetworkSEO@KGH.KARI.NET
  • This PIWP only just launched; however, this region participated in the pilot. E-news released in stroke month promoting the program with links from SE website to CorHealth website.
Southwestern Ontario
  • Provide new hire orientation
  • Other
Margo Collver margo.collver@lhsc.on.ca
info@corhealthontario.ca
  • A district within the SWOSN region was a pilot site for the core competencies. Components of the core competencies are utilized in the orientation of new staff.
Toronto Stroke Networks
  • Implement best practices
  • Improve patient outcomes
  • Perform needs assessment
  • Provide new hire orientation
Michelle Donald michelle.donald@sunnybrook.ca
info@corhealthontario.ca
  • Ten acute and rehab hospitals participated in piloting the Core Competencies.
  • Currently North York General Hospital has secured funds for protected time for nursing to identify education gaps using the framework. West Park Healthcare Centre will use framework to identify gaps and develop their education plan for stroke distinction.
  • The TSNs’ GTA Stroke Nursing Leadership Committee is developing a common approach for stroke teams to use the core competency framework to identify gaps in nursing education related to stroke and inform nursing learning plans.
  • Examples of framework use in the pilot and suggestions for ongoing use include orientation of new staff, team education, self-learning plans, performance appraisal goals, accreditation, and professional reflective practice.
West GTA
  • Implement best practice
  • Provide new hire orientation
  • other
Megan Sousa Megan.Sousa@thp.ca
info@corhealthontario.ca
  • Piloted on the Comprehensive Stroke Unit and the Outpatient Neuro Rehab Program (Mississauga Hospital) at Trillium Health Partners and at William Osler Health Services. The Core competencies are now being utilized by some of the hospitals as part of their new hire orientation and ongoing performance evaluations. The network continues to promote the Core Competnecy Framework at all workshops.

 

 

Casaubon LK, Boulanger JM, on behalf of the Acute Inpatient Stroke Care Writing Group. Acute Inpatient Stroke Care Module 2015. In Lindsay MP, Gubitz G, Bayley M, and Smith EE (Editors) on behalf of the Canadian Stroke Best Practices and Advisory Committee. Canadian Stroke Best Practice Recommendations, 2015; Ottawa, Ontario Canada: Heart and Stroke Foundation.