Saudi Stroke Standards

QM ToC 3: Transfer from a higher complexity to lower complexity stroke hospital Purpose  To ensure timely and safe transfer of patients from a comprehensive stroke hospital to a primary stroke hospital and then to rehabilitation facility, long term care facility or home.  To ensure availability of beds in Primary and Comprehensive Stroke Hospitals whenever needed. Rationale  For a stroke network to function effectively, a constant flow of patients out of each designated hospital to the other, is needed.  There is good evidence from the critical care literature that patients can get harmed if they are not appropriately accompanied by the right personnel and if the right procedures were not followed appropriately.  The number of beds at any facility are limited and should be utilized appropriately.  Seamless transfer of patients from one stroke hospital to another stroke hospital or other facility will allow patients to be treated in the appropriate place during their journey through the stroke pathway. Standards 1. All hospitals should have protocols of inter-hospitals and intra-hospital transfer of patients with the designated staffing, equipment and standards for EMS. 2. For comprehensive stroke hospital: a. If a patient comes from acute stroke ready hospital or primary stroke hospital for possible thrombectomy and then deemed to be not eligible for the intervention, this patient may be transferred back to the sending hospital or another appropriate hospital closer to patient’s home; except if medically indicated to be kept in a higher facility. b. The duration of stay should be determined in agreement between the two hospitals based on clinical pathways and protocols. c. There has to be urgent versus non-urgent protocols established within each hospital according to best practices and local circumstances. d. For patients who have had their intervention/thrombectomy done in the comprehensive stroke hospital, admission to the acute stoke unit within that facility is advised for stabilization and monitoring. e. After stabilization and monitoring, the patient should be transferred back to the same hospital, if his clinical condition is judged to be eligible to be transferred, and in accordance with the agreement of hospitals within the same network or repatriated to patient’s network. f. If the patient is stable to be discharged home, rehabilitation facility, or to long term care facility, then the comprehensive stroke hospital will ensure timely transfer. 3. For primary stroke hospital: a. All patients with acute stroke that did not need thrombectomy (hence did not need transfer to comprehensive stroke hospital) should be transferred from the emergency department to an acute stroke unit within the same facility, in a timely fashion, following hospital protocols. b. Patients who are clinically ready to be transferred to rehabilitation or long- term facility should do so based on the protocols within the hospital. 4. For the transfer of patients from stroke facility to rehabilitation, long term care, or home: a. Prior to discharge home, all patients should be assessed to determine the need for a home visit, which may be carried out to minimize safety risks and facilitate provision of appropriate aids, support and community services. b. Patients and families/care giver should have the opportunity to identify and discuss their post- discharge needs (e.g. physical, emotional, social, recreational, financial and community support needs) with relevant members of the multi-disciplinary team making decisions for discharge. c. All medications, equipment and support services necessary for a safe discharge should be organized and documented in the discharge summary. d. A documented post-discharge care plan is developed in partnership with the patient and family/care giver and a copy provided to them. This may include relevant community services, self-management strategies (e.g., including medications information and compliance advice, goals and therapy to continue at home), stroke support services (e.g., Stroke Foundations if available), any further rehabilitation or outpatient appointments, and an appropriate contact number for any queries. e. A discharge planner can be used to coordinate a comprehensive discharge program for people with acute stroke. 5. Each hospital should have clearly written protocols of the patient criteria that they can be admitted from and to another hospital within the same cluster. 6. EMS protocols have to be clear and easy to apply clinically. 7. Bed status in each hospital has to be known for both parties in each direction of care. B. TIA QM