Introduction: Stroke care spans the prehospital phase through community reintegration and places a burden on a health care system. As a leading cause of disability, it is important to implement strategies that ensure efficient transitions and adherence to quality-based processes. The stroke navigator (SN) manages care of acute stroke patients through rehabilitation by engaging with care providers and ensuring rapid flow of information and optimal decisions.


Objective: To measure the effect of the SN on emergency department (ED) to stroke unit admission wait times, onset days to rehabilitation, and cases adhering to Quality Based Procedures (QBP) at the Hamilton General Hospital.


Methods: Data was captured from the institutional data systems that continuously report measures in all stroke patients defined by ICD-10 criteria. Data was separated into two groups: before (BI) and after (AI) SN implementation. The student’s t-test (assuming equal variance) was used to calculate significance between groups, and effect size was calculated using Hedges g (an index of Cohens d) due to small sample size.


Results: 6885 patients contributed data over the years 2003 to 2017. The SN was associated with significant improvement in onset to rehab times with an average reduction of 7.44 days (p= 0.012618). ED to stroke unit admission times decreased by 2.8 hours (p= 0.001592) The proportion of QBP qualifying cases increased in the AI group, though the effect was not significant.


Conclusion: The inpatient stroke navigator significantly improves process of care and efficiency in a regional system by streamlining and improving transitions in care.

PROCESS AND QUALITY IMPROVEMENT ASSOCIATED WITH THE ESTABLISHMENT OF AN INPATIENT STROKE NAVIGATOR AT A HIGH-VOLUME REGIONAL REFERRAL CENTRE