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5th Edition
2015 UPDATE October, 2015

Acute Inpatient Stroke Care

Working Together with Stroke Survivors and their Caregivers to Achieve Optimal Outcomes is imperative across stroke systems of care, with the participation of individuals with stroke, their families and caregivers, healthcare providers, and the broader community. The primary underpinnings of ‘acute inpatient stroke care’ are to optimize recovery and patient outcomes. A coordinated and seamless system of care should be established in all hospitals and healthcare centres to ensure timely access to diagnostics and interventions, consultations with other services, and access to a range of rehabilitation therapies.

Achieving optimal outcomes for stroke survivors requires patients to be cared for on dedicated inpatient stroke units by healthcare team members with specialized stroke training, and establishment of evidence-based stroke protocols for all aspects of stroke care, including team meetings with case reviews, and early access to rehabilitation assessments and therapies. Hospitals that manage stroke patients and currently do not have dedicated stroke units should strive to implement all the core elements of stroke unit care, regardless of whether there is a designated stroke unit, and at least cluster stroke patients within a consistent area of a hospital ward and provide staff with education and skills training specific to stroke care. In hospitals where this goal is not possible within, acute stroke patients should be transferred to the nearest hospital that does provide acute stroke unit care.

Working Together, the core stroke team with other healthcare professions, should be developing an individualized management plan for each stroke patient. To accomplish this effectively, communication among healthcare professionals, hospital departments and primary care settings are paramount to ensure coordinated acute stroke care. Protocols should be established at all hospitals, based on the Canadian Stroke Best Practice Recommendations, and agreements should be in place for high priority rapid access to all specialists, departments and services required for each stroke patient to reduce risks of complications, optimize outcomes and meet patient and family needs during the early post-stroke recovery phase.

Working Together with Stroke Survivors and their Caregivers to Achieve Optimal Outcomes during acute stroke care also includes recognition that stroke can have devastating effects and not all patients will survive. For catastrophic strokes, both ischemic and hemorrhagic, the palliative care specialists within each hospital should be invited to be part of the care team as early as possible.

Updates and Changes in Acute Inpatient Stroke Care 2015 Update

The 2015 update of the Canadian Stroke Best Practice Recommendations Acute Inpatient Stroke Care module reinforces the growing and changing body of research evidence available to guide assessment, diagnosis, interventions and ongoing management of stroke patients following hospital admission.

Highlights of the moderate and significant updates as well as new additions to Acute Inpatient Stroke Care module recommendations for 2015 include:

  • Continued emphasis that organized stroke units with interprofessional stroke teams have the strongest evidence and a significant impact on patient outcomes following stroke.
  • Focus on the core elements and components of stroke unit care, and advocacy that the elements should be implemented as fully as possible within resource capability;
  • Edits to the section on reducing complications – specifically venous thromboembolism prophylaxis based on the results of the CLOTS 3 trial and early mobilization based on the most recent release of the AVERT trial.
  • Expanded guidance on addressing palliative care issues in patients with severe stroke.
  • Clarification within recommendations for initiating advance-care planning discussions with patients and family members.
  • Further development of a Taking Action Towards Optimal Stroke Care resource kit including stroke care information, educational modules, summary tables and resource links.
  • Updated patient order set templates for initial ED evaluation, tPA administration, acute inpatient admission, and management of intracerebral hemorrhage.

Guideline Development Methodology

The detailed methodology and explanations for each of these steps in the development and dissemination of the Canadian Stroke Best Practice Recommendations is available in the Canadian Stroke Best Practice Recommendations Overview and Methodology manual available on the Canadian stroke best practices website at http://www.strokebestpractices.ca/wp-content/uploads/2014/08/CSBPR2014_Overview_Methodology_ENG.pdf

Citing the Acute Inpatient Stroke Care 2015 Module

Casaubon LK, Boulanger JM, on behalf of the Acute Inpatient Stroke Care Writing Group. Acute Inpatient Stroke Care Module 2015. In Lindsay MP, Gubitz G, Bayley M, and Smith EE (Editors) on behalf of the Canadian Stroke Best Practices and Advisory Committee. Canadian Stroke Best Practice Recommendations, 2015; Ottawa, Ontario Canada: Heart and Stroke Foundation.


We invite comments, suggestions, and inquiries on the development and application of the Canadian Stroke Best Practice Recommendations.

Please forward comments to the Heart and Stroke Foundation’s Stroke Team at strokebestpractices@hsf.ca

Acute Inpatient Stroke Care Module Contents