Stroke patient transfers to Vancouver criticized

Delayed access to clot-busting drugs 'poor' care, Fraser Health review says

CT scan showing damage in the brain of a stroke victim.

Hospitals in Surrey, Abbotsford and New Westminster that are Fraser Health’s designated centres to treat stroke victims have so far failed to provide optimum care for them and redirect too many of those patients to Vancouver instead.

That’s one of the findings of a health ministry-ordered review of the health authority released earlier this month.

Many ischemic strokes can be effectively treated with clot-busting thrombolytic drugs, but time is of the essence – patients need to get to to stroke specialists within three to four hours for the treatment to be useful.

Too often, the review report said, those patients are diverted to Vancouver General Hospital instead of designated Fraser hospitals, adding extra delay when they should be treated in the region as quickly as possible.

The report said Royal Columbian Hospital has the expertise to treat those stroke victims but “capacity issues in the RCH emergency department make this site reluctant to accept more patient volume.”

Surrey Memorial Hospital’s ER and neurology departments haven’t embraced the use of thrombolytic drugs for stroke cases, it said, and Abbotsford Regional has made “some efforts” to meet its role as a designated site, but with “modest” results.

“This is poor patient care as it results in time delays to a treatment that is time-sensitive,” the review said of transfers to Vancouver.

Redirecting Fraser stroke patients to VGH worsens congestion there and demand on ambulance transfers, the report said, and means those patients must be transported back to Fraser later.

Fraser Health last year sent 135 stroke victims to VGH, some of them from as far away as Langley and Abbotsford.

Dr. Dave Williams, Fraser Health’s program medical director for medicine, said stroke services in the region are rapidly improving.

“We expect that number will be significantly reduced for this fiscal year because we have been able to build capacity at some of our sites,” he said.

Williams said he met ER doctors at Royal Columbian and resolved their concerns that the already congested hospital may be overwhelmed.

As a result, he said, RCH now is taking all stroke cases out of Eagle Ridge Hospital that were often being referred to Vancouver before.

A new stroke unit has opened at Surrey Memorial’s new critical care tower, he added.

Although it is still short of neurologists, more are being actively recruited.

“Abbotsford has actually made a lot of progress,” he said, adding four neurologists are in place there and the hospital is looking for a fifth to ensure round-the-clock coverage.

Recruitment is a challenge – the report notes neurologists specializing in stroke are concentrated in the Vancouver area.

Williams stressed anyone having stroke symptoms – such as facial droop, drift of the arm or speech problems – should call 911 immediately, even if the symptoms quickly stop.

The review also suggested too many Fraser region patients are treated for cardiac care at Vancouver Coastal hospitals, with less-than-ideal results.

About 25 per cent of angioplasties and 40 per cent of heart surgeries required by Fraser patients are performed at either VGH or St. Paul’s.

“There are significant wait time issues with an increasing number of patients exceeding the recommended wait time,” the review said.

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