List of Core Documents for



Table of Contents and

List of Supporting Material for Toolkit

|Purpose |Name of Documents / Form |Intended Use |Intended Users |

|Introduction |Table of Contents and List of Supporting Material |Lists all Phases and corresponding supporting documents |All referring sites |

| |A Toolkit Binder cover Page and Spine v3 |To insert on cover of binder of Toolkit |All referring sites |

| |B Letter of Introduction by Dr. Frank Silver, Telestroke |General introduction to Toolkit |All referring sites |

| |Medical Director | | |

| |C New Referring Telestroke Site Process - workflow |Summarizes all phases in becoming a new Telestroke |All referring sites |

| | |Referring Site | |

| | |Includes a list of supporting material | |

|Phase 1: Application |1A New Requesting Telestroke Site Eligibility Screening |Completed by new site and submitted to New Site |New referring site |

|Process |Checklist |Prioritization Group for review |New Site Prioritization Group |

| | |Forwarded to APTTT for final approval |APTTT |

| | | |OTN |

| |1B New Requesting Telestroke Site Readiness and |Completed by new site after it is deemed eligible and |New referring site |

| |Prioritization Documentation |submitted to New Site Prioritization Group for review |New Site Prioritization Group |

| | | |OTN |

| |1C Confirmation Letter |Official letter sent to new approved site by Chair of New |New referring site |

| | |Site Prioritization Group |Chair of New Site Prioritization Group |

| | | |OTN |

|Phase 2: |2A Site Implementation Planning Checklist |Outlines responsibilities for new site, RSC and OTN during |New referring site, OTN |

|Site Implementation Phase | |the implementation phase |Regional Stroke Centre |

| |2B Site Contact List |Lists all key contacts at new referring site, Regional |New referring site, OTN |

| | |Stroke Centre and OTN involved in implementation phase and |Regional Stroke Centre |

| | |ongoing | |

| |2CTelestroke Program Referring Site Information Package |To assist the Referring sites in developing their processes|Referring Site: administrative, nursing, |

| | |for implementing the Telestroke program within their |medical, diagnostic imaging departments |

| | |hospital; | |

| | |It identifies the key roles and responsibilities and | |

| | |provides tools and templates which can be adapted and | |

| | |incorporated into their Telestroke protocols. | |

| |2D Sample metrics data collection | | |

|Phase 3: Clinical |Clinical workflows for Telestroke | |Referring Sites |

|development phase |Telestroke Clinical Workflow |Summarizes the sequential steps taken during a Telestroke |Consulting neurologists |

| | |event by all parties involved, including the patient, the |CritiCall |

| | |referring site staff, CritiCall and the neurologist |OTN |

| | |on-call. | |

| | | | |

| | |Summarizes the billing and documentation process | |

| | | | |

| |Billing and Documentation Workflow |Summarizes the 24 hour Follow-up Workflow for Telestroke. | |

| | |This is optional. | |

| | | | |

| |24 Hour Follow up Workflow | | |

| | | | |

| | | | |

| | | | |

| |Three Month Telestroke Follow-up Clinic (Under | | |

| |Development) | | |

| |Clinical Protocols for Telestroke |Contains supporting tools to assist EDs in managing |Referring Site Emergency Dept |

| |Table of Contents |Telestroke ( nursing and physician checklists, sample | |

| | |forms, protocols, etc) | |

| | | | |

| |Section 1: Patient |Explains TS program to patients and families; to be given | |

| |OTN Patient Brochure on Telestroke |out by ER staff |Patients and families |

| |Section 2: EMS | | |

| |Section 3: Emergency Department Staff | | |

| |Section 4: CT Technologist | | |

| |Section 5: CritiCall | | |

| |Section 6: Neurologist | | |

| |Sample Clinical Protocols: | | |

| |Ottawa Hospital | | |

| |Pembroke Regional Hospital | | |

| |Peterborough Regional Hospital |Sample Case studies can be used to enhance understanding of| |

| |Sample Case Studies |the process and delineate the steps in the development of | |

| | |the clinical protocol. | |

| | | | |

| | | | |

| | | | |

| | | |Referring Site ER staff |

| | | |Clinical Educator |

|Phase 4: Education and |4A Education Workflow chart and Resources |Provides an indication of the breadth and depth of Acute |Referring Site – nurses and AHP |

|Training | |Stroke/Telestroke Education. The chart is especially |Regional Educator |

| | |useful to the key individuals/champions in the ED |Consulting Neurologist |

| | |overseeing the implementation of telestroke. Information |OTN Trainer |

| | |regarding educational resources is also included. | |

| |NURSING LEARNING OBJECTIVES for HyperAcute Stroke Patient |The learning objectives are indicative of the Competencies |Referring Site – nurses and AHP |

| |in ED with or without Telestroke |for the Emergency Department (Nurse). The objectives are |OTN Trainer |

| | |useful to the ED Nursing lead when planning education for | |

| | |staff. | |

| |Learning Plan Template |Tool to outline learning needs with respect to Hyperacute |Health care providers |

| | |Stroke and general stroke care. | |

| | | | |

| |Physician Competencies |Competencies for physicians in the ED of Telestroke |ER Physicians |

| | |Referring Sites. |Regional Stroke Education Coordinators |

| | | |ED Project Lead |

| |Sample Agendas and Workplan: |Some sample agendas to provide you with different ideas of |Regional Stroke Education Coordinators; ED |

| |Champlain Sample Workshop Agenda and sample Champlain |how the education session can be organized. |Project Lead |

| |Telestroke education Plan. | | |

| |Sample letter that accompanies the Champlain Outline to | | |

| |provide staff with information about the change, and for | | |

| |this educational event to have completed NIH online | | |

| |training in advance. | | |

| | | | |

| |Thunder Bay Sample Agenda for Kenora Acute Stroke | | |

| |Management workshop. | | |

| |Sample PowerPoints: |OTN Power Point providing background information on |Neurologist |

| |OTN Overview ppt |Telestroke |ER Physician Lead |

| |Dr. David Howse ppt (neurologist) |Clinical aspects of Telestroke - ppts for teaching ER |Regional Stroke Education Coordinator |

| |Dr. Lorne Scharf ppt (ER physician) |physicians | |

| |Dr. Sharma (pending) | | |

| |Sample Protocols (Ottawa, Pembroke and Peterborough): |3 full samples of clinical protocols for a code stroke |Referring Site – nurses and Allied Health |

| |Refer to Section 3 of this toolkit. | |Providers |

| |Contact information for all Regional Stroke Education |Contact information for OREG membership in the Ontario |New Referring site |

| |Coordinators (OREG) |Stroke System | |

| |Other Resources: |Telestroke Program Resource Binder located at |New referring site |

| |Table of Contents from the Telestroke Program Resource | and go to Regional Initiatives | |

| |Binder developed by the Northeastern Ontario Stroke |where the Telestroke binder is listed as the last item on | |

| |Network. |the drop down menu. | |

| | | | |

| |"Telestroke in Action" short videoclip produced by North | | |

| |Bay General Hospital. | | |

| | | | |

| | | | |

|Phase 5: Mock Consultation |5A Mock consultation test plan |Checklist describing responsibilities of all key |New Referring site (ER staff, DI staff), |

|Phase | |stakeholders during a mock consult |OTN Service Desk Neurologist on call, |

| | | |CritiCall |

| |Sample Case Study |Case Study describing acute stroke scenario – can be used |New referring site |

| | |for mock consultation |Neurologist |

| | | | |

|Phase 6: Live Site Notice |Live Site Notice for Technical readiness |Notice sent to new site and OTN stakeholders announcing the|New Referring site |

|Phase | |site is technically live and ready for activity |OTN Service Desk |

| |Live Site Notice for Clinical Readiness |Sent to key stakeholders from OTN to officially announce |New Referring Site |

| | |date and time a new site is added to the TS roster; |Consulting Neurologists |

| | |patients will now be accepted |CritiCall |

| | | |OTN Service Desk |

| | | |Other participating referring sites |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download