For more information on Toronto Stroke Networks Initiatives please contact your Regional Stroke Network and/or click on the embedded links.
Access to Hyperacute Care in Toronto
Description: The vision for this initiative is that all eligible patients receive timely best practice hyperacute care at the right place to improve outcomesâ. Many organizations are still not meeting best practice standards for hyperacute care. Organizations have inconsistently and with varying success, implemented walk-in and inpatient code stroke protocols. The TSNs are planning to âsupport implementation and standardization of the process to enable identification of walk-in and inpatient code stroke patients resulting in better outcomes. The TSNs intend to collaboratively develop standard tools, resources and education that can be adapted locally and facilitate the execution of hyperacute care at the right time and the right place.
Click here to learn more about Access to Hyperacute Care in Toronto.
Setting: Â Cross continuum
Automatic Acceptance & Bed Offers
Description: All patients with AlphaFIMŸ 40-80 (referred †7 days post stroke) should receive an    automatic bed offer for high intensity rehab. Future work will focus on automatic acceptance/bed offers for all patients (with rehab goals) and a centralized referral intake system to support flow of patients through the continuum of care.
Click here to learn more about the Automatic Acceptance & Bed Offers initiative.
Setting: Â Acute and inpatient rehabilitation
Building Capacity in Psychosocial and Hopeful Care: Education and Knowledge Translation Program
Description: An evidence-informed, multi-modal education and knowledge translation program for healthcare providers working in stroke care. The purpose of this initiative is to improve the life experience of persons with stroke and their families/caregivers through focused attention on psychosocial care and promoting a culture of hopeful care.
Click here to learn more about the Building Capacity in Psychosocial & Hopeful Care initiative.
Setting: Â Cross continuum
Canadian Occupational Performance Measure© (COPM©)
Description: The Canadian Occupational Performance Measure© (COPM) is a patient reported outcome measure (PROM) and supports the patient reported experience measure (PREM) process. It focuses on the patientâs most important needs and measures the most relevant outcomes. It detects change in a patientâs self-perception of their task and activity performance over time, and promotes evidence-based practice.  The COPM© improves the patientâs experience by supporting the clinicianâs ability to establish a positive relationship with the patient. The COPM© is being implemented across the continuum to help patients identify their goals and rate their performance and satisfaction across all stages of their recovery to support Integrated Stroke Care. We are monitoring and reporting on the completion of COPM© to understand patient outcomes using standardized language and to support seamless transitions for the patient.
Click here to learn more about the COPM© initiative.
Setting:Â Cross continuum
Cognitive Orientation to daily Occupational Performance (CO-OP)
Description:  CO-OP is is a performance-based, problem-solving approach that enables skill acquisition through a process of strategy use and guided discovery. CO-OP was initially implemented at 5 rehabilitation sites using an evidence-informed knowledge translation approach to facilitate increased access to rehabilitation for persons with stroke and cognitive impairment. CO-OP implementation has been expanded to include acute care, an integrated stroke unit and outpatient rehab.
Click here to learn more about the CO-OP initiative.
Setting:Â Â Acute care, Rehabilitation
Community Forum
Description:Â The Toronto Stroke Networks will be hosting a Community Forum on June 8th, 2022. Community stroke care providers will be invited to attend sessions that will provide education and practical ways to incorporate various community stroke best practice initiatives, tools and resources into their practice.
Click here to learn more about the TSNs Community Forum initiative.
Setting: Community
Community Stroke Rehabilitation (CSR) Competency Based Framework
Description: The Community Stroke Rehabilitation (CSR) Competency Based Framework is a resource currently being developed in collaboration with the Central East Stroke Network with the plan to pilot in the spring of 2022. This framework will help CSR team members develop expertise in delivery of stroke care. The CSR Competency Based Framework is being built on to the VCoP and will contain 1) a comprehensive checklist of competencies for CSR team members which are based on stroke best practices; 2) a method to self-assess level of achievement in each competency; 3) a way to develop learning plans and track annual progress; and 4) a process to support implementation and sustainability.
Click here to learn more about the CSR Competency Based Framework initiative.
Setting: Community
Essential Professional Conversations (EPCs
Description: The idea of Essential Professional Conversations (EPCs) grew from the Transitions Improvement for Continuity of Care (TICC) and Knowing Each Otherâs Work (KEOW) initiatives. EPCs or âwarm handoversâ are enhanced verbal exchanges between health care providers about patients at the time of the patientsâ transition between programs or sites. The goal of EPCs is to facilitate continuity of care and promote hope at an uncertain time for the patient and their family/caregivers.
Click here to learn more about the Essential Professional Conversations initiative.
Setting: Cross continuum
Framework for Implementing Sustainable Change
Description: The Toronto Stroke Networksâ (TSNs) Framework for Implementing Sustainable Change was developed and refined through a series of sessions with regional stakeholders using human-centered design principles.  Knowledge obtained from design thinking, prior implementation of TSNsâ initiatives and the Gailbraithâs Star Model analysis were integrated into the framework.  A concurrent review of relevant literature was completed to ensure the framework reflected best practice.
The Framework for Implementing Sustainable Change is comprised of three components: self-reflection and collaboration, the implementation cycle, and human factors.  Utilization of this framework will facilitate regional implementation of initiatives that support best practice in stroke care.
Click here for more about the Framework for Implementing Sustainable Change initiative.
Setting: TSNs' Team
Guide for Stroke Recovery (GSR)
Description: The Guide for Stroke Recovery (GSR) is a self-management and education resource for persons with stroke and family/caregivers to promote understanding of common issues after stroke and prevention of recurring strokes. This resource is available in PDF format in the following languages: Italian, Portuguese, Punjabi, and Simplified Chinese. The GSR website is based on the book and provides practical support through videos, tips and strategies and links to community resources. Two workshops have been developed to support healthcare providers:
- GSR workshop: This 1.5 hour workshop equips clinicians with knowledge and skills to: introduce the GSR and describe its value to persons with stroke, families/caregivers; support patients to manage their care and recovery with the use of the GSR; and support patient education, goal setting, transitions of care, and community reintegration.
- Choices and Changes â Utilizing the Guide for Stroke Recovery: Application of the Guide for Stroke Recovery has been integrated into a provincially recognized education framework and workshop, âChoices and Changes: Motivating Healthy Behavioursâ. This full-day workshop equips clinicians with knowledge and skills to motivate change in patients/clients for better health outcomes.
Click here to learn more about the GSR initiative.
Setting: Cross continuum
Integrated Care for Stroke: System Planning
Description: Leveraging the learnings from the Integrated Funding Model Pilot Project, this work focuses on developing and implementing a system-level approach to integrated funding for stroke. This initiative involves working with system stakeholders across the continuum of care on a geographical hub model, where each hub includes inpatient rehab, outpatient rehab (regular and early supported discharged streams), and home-based rehab (regular and early supported discharge streams). The goal is to create a sustainable stroke care system where outcomes are shared across stakeholders and equitable access and quality stroke care for our patients is maintained
Setting: Cross continuum
Orientation to Stroke Care in Toronto
Description: The Orientation to Stroke Care in Toronto resource has been created for all new staff working in stroke care. It is a module found on the VCoP that provides high level information and resources available in Torontoâs stroke system.
Click here to learn more about the Orientation to Stroke Care in Toronto initiative.
Setting: Cross continuum
Patient & Family Experience Questionnaire
Description: The Patient and Family Experience Questionnaire (PFEQ) was implemented in 2017 to help us better understand the experiences people have as they access the system of stroke care in Toronto. In order to capture reflections on the entire experience in the stroke system, the PFEQ is targeted for dissemination when the majority of care is complete (e.g. in secondary stroke prevention clinics and outpatient rehabilitation settings). The PFEQ is available in both paper and online format. Aphasia-friendly versions are also available.
Click here to learn more about the Patient & Family Experience Questionnaire
Setting: Â Outpatient Rehabilitation, Secondary Stroke Prevention Clinics, and Community Services
Regional Access to Stroke Unit Care
Description: The vision for this initiative is to Improve patient outcomes by ensuring all persons with stroke have access to stroke unit care across Toronto â. It has been shown that individuals who receive stroke unit care have lower mortality rates, reduced impairments and improved quality of life. These benefits are seen in older and younger patients, men & women, and in people with different types of strokes and varying severity. However, In Toronto there is inconsistent access to stroke unit care and there is a widening gap in access compared to provincial performance.
Click here to learn more about the Regional Access to Stroke Unit Care.
Setting: Cross continuum
Standards of Care
Description: As a platform for continuous quality improvement, the Standards of Care resource was created in 2019 and is intended to provide an overview of key stroke best practices and how these practices have been implemented across the continuum in Toronto. The vision for Standards of Care is âto be accountable leaders and innovators, continuously creating and achieving shared best practice standards of excellence in stroke care that are accessible across geographical boundaries".
Click here to learn more about the Standards of Care initiative.
Setting: Cross continuum
Stroke Care Observerships (SCOs)
Description: Stroke Care Observerships (SCOs) grew from the Transitions Improvement for Continuity of Care (TICC) and Knowing Each Otherâs Work (KEOW) initiatives. SCOs were developed to provide an in-depth learning opportunity which would enable health care providers to get to know each otherâs work (including physical setup, approach, advantages and barriers). The goal of SCOs is to develop a one-team approach and foster seamless care for persons with stroke. Engaging in SCOs will result in greater trust between health care teams and an enhanced patient experience with improved clinical outcomes.
Click here to learn more about the Stroke Care Observerships initiative.
Setting: Cross continuum
Stroke Prevention
Description: The Regional Secondary Stroke Prevention Working Group collaborates on supporting the implementation of best practices as per Ontarioâs Stroke Prevention Clinic (SPC) Core Elements and co-developing standardized processes, where applicable, to support equity, access and care to secondary stroke prevention services in Toronto.
Click here to learn more about the Stroke Prevention initiative.
Setting: Stroke Prevention
Supporting Stroke Best Practices in Primary Care
Description:Â The TSNs are engaging, building and strengthening partnerships with our Primary Care stakeholders in order to inform, promote and support stroke best practice implementation in this area of practice.
Click here to learn more about the Stroke Best Practices in Primary Care initiative.
Setting: Primary Care
TSNs Annual Collaborative
Description: The Annual Collaborative is an annual event held by the TSNs, which brings together Healthcare Providers across the continuum to obtain insight and provide information and current state in relation to the yearâs strategic priorities.
Click here to learn more about TSNs Annual Collaborative initiative.
Setting:Â Cross continuum
TSNs Health Equity Framework
Description: The purpose of this initiative is to give all persons with stroke the best chance to receive the care they need. By doing research to understand the health equity experience of persons with stroke in Toronto, we are creating a stroke-specific Health Equity Framework which will be used to inform all TSNs initiatives, in turn improving patient experience, access to best practice stroke care as well as patient outcomes. We are also working collaboratively with Ontario Health and GTA Rehab Network/Rehab Care Alliance (RCA) to support the development and implementation of health equity indicators that can be centrally collected, and applied to stroke across the continuum. This will assist with stroke system-planning and decision-making.
Click here to learn more about TSNs Health Equity Framework initiative.
Setting: Cross continuum
TSNs Virtual Community of Practice (VCoP)
Description: The Toronto Stroke Networks Virtual Community of Practice (VCoP) is an interactive social media platform for any person working, providing care, researching, and learning in the area of stroke care. The VCoP has been utilized as a knowledge translation resource to support interprofessional collaborative learning and system-wide integration of stroke best practices.
Click here to learn more about the VCoP initiative.
Setting: Cross continuum
Virtual Care
Description: This initiative is meant to evaluate the implementation of virtual care in the Outpatient Rehabilitation setting across Toronto and the GTA. This will lead to the identification of successes and opportunities for improvement. In doing this, the goal is to uncover what current resources and best practices exist, and understand the needs of our stakeholders in regards to the use of virtual care in their practice.
Click here to learn more about the Virtual Care initiative.
Setting: Outpatient Rehabilitation, Secondary Prevention Clinics