Using Stroke Care Observerships to Support Transition Experiences During the Repatriation Process

On September 20, 2018, interprofessional representation from Sunnybrook’s C4 Acute Stroke Unit and North York General Hospitals’ Neuro Unit participated in a Stroke Care Observership (SCO) at North York General Hospital.

During the SCO, these 2 teams discussed ways to improve the care and transition experience for patients transferred from Sunnybrook Health Sciences Center to North York General Hospital.  From this discussion, some key learnings included increased awareness of:

• the types of information that are needed to support transitions and early assessment/management of the patient at the next care environment;
• the need to leverage existing resources such as Essential Professional Conversations (warm clinical handovers) to support healthcare provider communication and patient transitions;
• what to expect at the next care environment; and
• the importance of ongoing communication and collaboration between the 2 acute care teams

Overall, participants valued the SCO experience as it provided a deeper understanding of each other’s care environments. Both teams have expressed a strong interest to continue the conversation and collaboration with each other.

As SCOs in the past involved one care team visiting another care team from a different sector (e.g., acute care visiting inpatient rehab), this marked the first time when 2 acute care teams planned and participated in a SCO to support transition experiences for repatriated patients and their families.  As learnings from this SCO will also inform system planning, the Toronto Stroke Networks thanks the Sunnybrook C4 Acute Stroke Unit and North York General Hospitals’ Neuro Unit for their time and support in planning and participating in this SCO.

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