Organization of Stroke Services in Canada

Within the Canadian healthcare system, there are generally three types of facilities that provide stroke services. The CSS categorizes these as comprehensive stroke centres, centres providing intermediate stroke services, and centres lacking specialized stroke resources.

Comprehensive stroke centres have specialized resources and personnel available 24 hours a day, 365 days a year to assess and manage stroke patients. These facilities have established written stroke protocols for emergency services; in-hospital acute care and rehabilitation; the ability to offer thrombolytic therapy to suitable ischemic stroke patients; timely neurovascular imaging and expert interpretation; and coordinated processes for patient transition to ongoing rehabilitation, secondary prevention, and community reintegration services. Comprehensive stroke centres have neurosurgical facilities and interventional radiology services, and play a leadership role in establishing partnerships with other hospitals to support stroke services. As a rule, comprehensive stroke centres also have a performance measurement system in place to monitor the quality of stroke care and patient outcomes.

Centres providing intermediate stroke services are staffed with on-site clinicians who have stroke expertise. These centres have written stroke protocols for emergency services, acute care and/or rehabilitation; the ability to offer thrombolytic therapy to suitable ischemic stroke patients or protocols to transfer appropriate patients to a comprehensive stroke centre; timely neurovascular imaging and timely access to expert interpretation on-site or through the use of telemedicine technology; and coordinated processes for patient transition to ongoing rehabilitation and secondary prevention services. Centres providing intermediate stroke services may use telemedicine technology to access stroke expertise from a comprehensive stroke centre to support early management of acute stroke patients.

Centres lacking specialized stroke resources do not have in-facility resources such as clinicians with stroke expertise or neuroimaging. It is important that these centres establish written agreements for timely transfer of stroke patients to centres with higher levels of stroke care.

A glossary of terms and definitions can be found in Appendix 5.