Osler’s Stroke Dashboard a ‘game-changer’ for high quality stroke care

BRAMPTON, ONT. – The marriage of old and new technologies at William Osler Health System (Osler) is not only yielding impressive results in the care of stroke patients, the organization’s new Stroke Dashboard is also among the first in Canada to deliver real-time stroke care data in a visually friendly digital format.

“At any given time, we can be caring for over 50 inpatients across our two stroke units or elsewhere throughout our Brampton Civic and Etobicoke General Hospitals,” said Anne-Marie Graham, Osler’s director, Cardiovascular, Chronic Disease, Stroke and Wound.

“During each patient’s care pathway, they are regularly assessed for over 21 different quality care metrics based on Canadian Stroke Best Practice. Having access to real-time data on each individual patient is crucial to providing quality stroke care and ensuring each patient is on track in their recovery plan and assessment.”

Prior to introducing the Stroke Dashboard at Osler, tracking stroke quality metrics was a labour-intensive process, compounded by monitoring patients on multiple units across two hospital sites. The stroke team previously used bullet rounds and a Kardex worksheet to manually track each patient’s progress on their respective care pathway.

“We needed a singular forward-thinking approach with at-a-glance features to ensure each patient was meeting the right milestones on their care pathway at the right time,” said Terri Lynn Hansen, Osler’s director, Acute General Medicine, Critical care, Respiratory Therapy and Transitions, and former director of Osler’s stroke program. “The Stroke Dashboard has been an absolute game-changer for the team in terms of patient flow and quality care management.”

Built in-house, the dashboard was the brainchild of a working group consisting of cross-departmental stakeholders, including representatives from Osler’s Decision Support, Applications, and Information, Intelligence and Technical Innovation (IITI) teams.

Leveraging knowledge used to build Osler’s highly successful digital Operational Command Centre and adopting visual aspects of the organization’s electronic Transfer of Accountability, the Stroke Dashboard applied Microsoft-powered Business Intelligence (BI) to pull data from Osler’s existing Meditech system.

“We use the Power BI to run Structured Query Language (SQL) queries against the Meditech database, including admissions, nursing modules, order entry modules, health records, home care referrals and rehabilitation referrals,” said Rachelle Maguire, Osler Systems Analyst, Applications. “The dashboard pulls all the information the stroke team needs on patients in real-time, without the user having to go into various modules to look for it.”

Among its many features, the Stroke Dashboard uses a visually effective set of green checkmarks and red ‘x’s in a column format that help frontline staff quickly view what milestones along each patient’s journey have been completed and which ones are yet to be done. Have they had their ECG? Have they had their echocardiogram? Has a swallowing assessment been carried out?

If a milestone doesn’t apply to a particular patient, it is indicated as a ‘n/a’ to ensure a timely discharge.

“The beauty of the dashboard is that it consolidates the information the stroke team needs about all of its patients together in one place at the click of a button, regardless of where those patients are in the hospital,” said Maguire, whose team works with stakeholders to continually evolve hospital dashboards to ensure they are consistently meeting users’ needs and are patient-centred.

Stroke team members can access the dashboard from a wall-mounted screen in the report room on each unit, or from individual computers using secure access. Staff can also safely view the dashboard from Osler’s Operational Command Centre.

Since launching the Stroke Dashboard in May 2023, its use has led to a 1.9-day reduction in stroke patients’ length of stay and a 10 percent increase in Alpha-FIM completion within three days, as well as reduced wait times for other tests.

Alpha-FIM is a standardized method of assessing patients to determine how debilitating their stroke is and who will need a longer period to progress through their recovery.

“From a best practice perspective, we can immediately see if there are stroke patients in the emergency departments or intensive care units who need to be admitted to one of our stroke units, if we need to escalate a test that a patient hasn’t yet received, or if a patient has achieved all their milestones and is ready for discharge,” said Julie Merhar, Osler’s clinical manager, Stroke Program.