First neurovascular unit opens at Krembil Neuroscience Centre

The first neurovascular unit (NVU) in Canada opened today at the Krembil Neuroscience Centre, Toronto Western Hospital, which is part of the University Health Network. The 20 bed in-patient unit is designed to provide patients with stroke and neurovascular conditions such as aneurysms and diseased blood vessels in the brain with the most optimal setting for treatment as well as the initial stages of recovery.

"We designed our neurovascular unit based on extensive research that shows stroke units in hospitals improve patient outcomes," said Dr. Frank Silver, neurologist and Director of the University Health Network Stroke Program.

According to the Canadian Stroke Strategy, stroke patients who are cared for in a designated stroke unit, by a team of health-care professionals have a reduced likelihood of death and disability by as much as 30 percent. Stroke patients receiving organized in-patient care in a stroke unit are more likely to be alive, independent, and living at home one year after the stoke.

A team of experts at the KNC used this rationale for the new unit, but took it a step further. "We believe that the same reasons stroke patients have better outcomes in dedicated stroke units also apply to patients with other neurovascular conditions," said Dr. Mike Tymianski, Medical Director of the Neurovascular Therapeutics Program and Interim Head of the Division of Neurosurgery at the University Health Network. "There are many similarities between what appears to be a very diverse patient population - it makes sense to bring all of our expertise together to treat stroke and neurovascular patients."

This innovative approach depends on a highly specialized, multidisciplinary team (including, neurologists, neurosurgeons, neuro-radiologists, RNs, Advanced Practice Nurses, and allied health professionals), who circulate through the unit to deliver expert care. In most Canadian hospitals, patients being treated for stroke and neurovascular diseases are spread amongst several different units.

"We are very excited to be leaders in the area of stroke care," said Kathy Sabo, Vice President of Toronto Western Hospital. "Our new unit will also focus on collaborative research that will enable an evidence based approach to patient care and improved health outcomes."

In conjunction with the University Health Network's Centre for Innovation in Complex Care, the Toronto Western Hospital's neurovascular unit will be measured against a number of goals including:

•Average patient stay of 5 days
•Fewer readmissions
•Improved health outcomes
•Improved rates of return to work
•Reduced health-care costs

In addition to in-patient care, the NVU also features Toronto's only day unit for Transient Ischemic Attacks (TIA) and minor strokes, called the TAMS Unit. Traditionally, patients suffering from a TIA or minor stroke who present in a hospital emergency room are either discharged and referred to a stroke prevention clinic or admitted to hospital (averaging a stay of up to three days). The stroke team at the Krembil Neuroscience Centre identified a more effective way of treating these patients by creating a rapid assessment day unit.

"The key to caring for these patients is getting tests done urgently to identify conditions that predispose patients to a higher risk of stroke and that warrant specific treatments, or to confirm there is no imminent danger of a major stroke. Furthermore, it is important that we educate patients about stroke and stroke prevention, including lifestyle changes and treatments for stroke risk factors," said Dr. Leanne Casaubon, neurologist and lead for the TAMS Unit development. "The TAMS Unit provides same day diagnostic tests, treatment and education while avoiding unnecessary hospital admissions."

Timely care is especially important for these patients because TIAs and minor strokes are often the first warning sign of a potentially catastrophic major stroke. According to data from the Registry of the Canadian Stroke Network, almost 10 percent of patients presenting with a TIA have a subsequent stroke within a month, and half of the cases of stroke occurred within the first two days after the TIA.

"As a regional stoke centre in Toronto and as a hospital that takes in some of the most complex neurosurgeries for cerebrovascular conditions in Canada, we have a chance to implement innovative changes that could impact how hospitals around the world care for these patients," said Mary Ann Neary, Clinical Director of the Krembil Neuroscience Centre.