The Acute Stroke Pathway focuses on key interventions in the first few hours after onset of stroke symptoms. Timely and appropriate assessment and treatment during this period can significantly assist patient recovery. Pathway protocols are informed by the Canadian Best Practice Recommendations for hyperacute stroke care.
The Saskatchewan Stroke Expert Panel (SSEP) provides oversight for stroke care improvements including the Acute Stroke Pathway. For more information about the SSEP, see further down.
Occasionally, the SSEP issues clinical stroke advisories to support best practices.
The Acute Stroke Pathway recommends that all patients up to 12 hours from symptom onset and selected patients up to 24 hours are also treated as stroke alert and emergently transported to a primary stroke centre for advanced imaging (CTA).
Under this protocol, most patients benefit from early comprehensive assessment and diagnosis, which sets the stage for better recovery and secondary prevention. Some patients will be eligible for hyperacute treatment. While intravenous thrombolysis (TPA) is still associated with best outcomes within 4.5 hours, patients can be eligible for endovascular thrombectomy (EVT) up to 24 hours from the onset of symptoms.
Patients presenting with symptoms of TIA or mild stroke must be assessed for risk of stroke recurrence using the high risk TIA protocol. High risk patients will require neurological consultation and advanced imaging at the nearest primary stroke centre.
Whether stroke alert is called by EMS personnel or in a local health centre, patients should be transported directly to a CT-enabled hospital where there is access to advanced imaging and assessment.
The Acute Stroke Pathway provides the following tools and order sets to guide best practice care and support data collection and reporting. Other than the exceptions noted in the guideline for implementation of order sets, orders are as per current evidence and national standards and should be fully implemented.
Guideline for implementation of order setsInformation about TIA patient education booklet - NewReferral & triage tool for TIA non-disabling stroke - November 2018EMS standardized stroke screen - Revised March 2019EMS VAN screen job aid - Revised March 2019Evaluation of in-hospital stroke - Revised March 2019Initial evaluationStroke admissionAlteplase (tPA) Thrombolysis w pumps - Revised March 2019Alteplase Exclusion Criteria - Revised March 2019
The SSEP was created in 2016 to monitor the quality of stroke care in Saskatchewan, develop strategies and provide direction for improvement. The SSEP provides oversight and direction for the Acute Stroke Pathway while also bringing attention to opportunities for improvement along the continuum of stroke care including stroke prevention, hospital care and rehab.
Clinical Stroke Advisory 2019-01 – Stroke Alert up to 24 Hours for Suspected Large Vessel Occlusion
Clinical Stroke Advisory 2018-01 – High-Risk TIA Protocol
Clinical Stroke Advisory 2017-01 – Consent for IV Contrast
For comprehensive resources on stroke best practices for health care providers, visit www.strokebestpractices.ca/resources/professional-resources
Information for Patients