Format of Best Practice Recommendations

Each recommendation consists of a number of pieces of significant information, presented as follows.

• The best practice recommendation describes the recommended practice and provides specific direction for front-line staff and caregivers for delivering optimal stroke care.
• The rationale summarizes the importance and the potential impact of implementing the recommendation and states its relevance to stroke care delivery or patient outcomes.
• The system implications provide information on the mechanisms and structures that need to be in place if health systems, facilities, front-line staff, and caregivers are to effectively implement the recommendation (see 2.6.1 for details).
• The performance measures provide managers and administrators with a standardized and validated mechanism to consistently monitor the quality of stroke care and the impact of implementing the best practice recommendation. The most significant performance measures are highlighted in bold type. The others, while also important, are for those able to conduct a more extensive stroke practice evaluation.Performance measures that are part of the CSS core indicator set are indicated by the notation (core) following the indicator statement. Refer to Appendix 8 for a full list of core indicators.

• The implementation resources and knowledge transfer tools provide links to tools developed or recognized by the Canadian Stroke Strategy and/or their partners and collaborators. These resources include “how-to” guides, educational materials for healthcare professionals and patients.  This section also identifies patient assessment and outcome measurement tools that have been found through consensus to be valid, reliable and  relevant to stroke populations.
• The summary of the evidence summarizes the most compelling and strongest evidence available as of September 30, 2010 related to the recommendation.

2.6.1 System Implication Categories: Each recommendation is accompanied by system implications. These are actions and mechanisms that are needed for high-functioning systems of stroke care, and that require leadership and/or coordination at the regional or provincial or territorial level. The system implications fall into four broad categories.

First, and central to effective awareness and prevention strategies as well as stroke recovery support, is the need for community-wide efforts. This could include collaborations among non-profit organizations such as the Heart and Stroke Foundation and the YM/YWCA, municipal departments of health and recreation, expanded roles for community-based healthcare professionals such as pharmacists, and trained volunteers such as those providing peer-to-peer support.

Second is the need for engagement and effective partnerships in the organization and delivery of stroke care across the continuum. This would include collaboration in the development and administration of referral and transfer agreements, stroke care protocols, and communication mechanisms. There should be plans and mechanisms in place to effectively respond to the needs of stroke patients no matter where they live.

Third is the importance of education. This includes professional development for healthcare providers managing patients across the continuum of stroke care as well as education for patients, family members, caregivers, and the community-at-large. Education includes information about stroke and the development of skills and expertise in caring for stroke patients.

Fourth is a strong commitment to continuous performance improvement at all levels of the healthcare system. This requires measurement and monitoring strategies that includes surveillance and monitoring front-line service delivery at national, provincial or territorial, and regional levels.

Responsibility rests with provincial and territorial governments and regional health authorities to ensure all Canadians have access to the best possible stroke care, and to provide the resources necessary to implement and sustain effective evidence-based healthcare services and monitoring strategies for stroke.