Icons depicting tpA administration, clot retrieve and stendt and catheter.

Endovascular Treatment (EVT) System Improvements

Updated Provincial Endovascular Treatment (EVT) Referral and Transport Process Approved

For the past 2 years, CorHealth Ontario has been working collaboratively with various stakeholders to support maturation of the provincial Endovascular Therapy EVT system to ensure Ontarians have equitable access to high quality care. Critical to this work is the establishment of a referral and transport processes to reflect the time urgency of stroke treatment and the geographical landscape of Ontario.

In 2019, CorHealth Ontario’s EVT Steering Committee approved and disseminated a comprehensive and updated provincial EVT Referral and Transport Process; a document which now replaces the previous Transport Memo dated March 20, 2017. These revisions reflect the collaborative efforts of key stakeholders such as CritiCall Ontario, ORNGE, Emergency Medical Services, the Ontario Telestroke Program, the Regional and District Stroke Networks and EVT specialists from across the province.

These updates aim to provide further clarity with respect to:

  • The roles and responsibilities of referring and receiving hospitals
  • Criticall’s one number to call process and system transport recommendations
  • The Clinical criteria for clinical escort and eligibility for transport when greater than 2 hours transport door to door from an EVT hospital.
  • Current best practice standard imaging protocol for referring sites.

To access this resource, please visit CorHealth Ontario’s EVT Resource Centre or click here.

Health Sciences North - New EVT Hospital

In late 2018, CorHealth Ontario developed a process to support organizations who may be interested in expanding their current stroke programs to include endovascular thrombectomy. This process requires that organizations demonstrate a clear gap in services that cannot be met by existing programs and endorsement from their Local Health Integration Networks (LHIN), Regional Stroke Steering Committees, CorHealth Ontario and the Ministry of Health and Long-Term Care (MOHLTC).

We are happy to announce that in the Spring of 2019, Health Sciences North (HSN) completed this process and received endorsement by CorHealth Ontario, and the MOHLTC approved 19/20 funding for the program (go live 2019/2020). This will bring the number of hospitals providing EVT services to 11 in Ontario. It is anticipated that the HSN program will address a significant gap in access for Ontarians living in Northeastern Ontario.

Paramedic Prompt Card

In December 2018, the Provincial EMS/Patient Transport Task Group recommended a revision to The Cerebrovascular Accident (CVA, “Stroke”) Standard and associated prompt card in the Basic Life Support Patient Care Standards (BLS PCS). Specifically, the task group recommended changes to enable paramedics to tailor transport decisions based on the clinical needs of the stroke patient. This recommendation reflects new evidence which suggests that, for a select group of patients, direct transport to an EVT capable centre may be associated with improved patient outcomes.

In response to these recommendations, the Stroke Standard was updated in May 2019 to enable transport to “the closest or most appropriate Designated Stroke Centre.” These changes came into force on September 3, 2019.

To support these changes, the EMS/Patient Transport Task Group has recommended the use of the Los Angeles Motor Scale by paramedics to identify patients who may benefit from direct access to EVT. In addition to these recommendations, the group is currently in the process of developing a toolkit to support implementation and standardization of direct access where geographically appropriate. Stay tuned!

CorHealth Ontario EVT Resources

All CorHealth Ontario EVT Resources can be found on the CorHealth website: https://www.corhealthontario.ca/resources-for-healthcare-planners-&-providers/evt

September 2019 Articles: