Transient Ischemic Attack (TIA)

Rapid assessment and management of TIA has been shown to reduce the risk of recurrent events.  Efforts to implement rapid assessment strategies have been underway as part of stroke care reorganization in the province; however, access remains a challenge in many areas of the province.  CVHNS developed algorithms for rapid assessment in Emergency Departments and Primary Health Care and reviewed current rapid access strategies across the province.  This is the beginning of developing a sustainable, provincial approach to TIA rapid assessment and management. The algorithms were disseminated to family physicians and Emergency Departments in 2016. Accredited education sessions on TIA Diagnosis and Treatment continue to be offered across the province. 

Stroke Rehabilitation

To date, provincial stroke reorganization has focused on the creation of comprehensive stroke units throughout the province, including access to high quality acute care and early rehabilitation.  Access to rehabilitation following the acute phase and meeting the Canadian Stroke Best Practice Recommendations, may require additional reorganization.  CVHNS:

  • facilitated a follow-up project where stroke patients were interviewed three months after discharge about their needs and challenges during the transition home
  • facilitated a prospective audit of stroke patient access to rehabilitation services, and
  • coordinated database linkages to assess ongoing access to rehabilitation services.
This work is intended to help inform recommendations for stroke rehabilitation in the province.

Promoting Practice Change through Shadowing Experiences at Tertiary Care Sites

CVHNS supported staff from sites around the province to participate in two types of shadowing experiences.  Forty-five staff participated in shadowing experiences at the cardiac catheterization lab.  These were designed to improve understanding of the procedure and subsequently preparation for cardiac catheterization at the local site, prior to transfer.  Twenty-seven staff from Restorative Care Units participated in shadowing experiences at the Nova Scotia Rehabilitation Centre. These were designed to support stroke practice change based on learning needs identified by the individual. 


Updates to 2008 Nova Scotia Guidelines for Acute Coronary Syndromes

The antiplatelet sections of the Nova Scotia Guidelines for Acute Coronary Syndromes have been updated. Physician champions from each former health authority reviewed the draft guidelines; recommendations were based on current evidence and group consensus.  CVHNS also worked with the Diabetes Care Program of Nova Scotia (DCPNS) to update the diabetes sections of the guidelines.  Local surveys and audits were completed to learn more about current practices and approaches to care and the need for continuing education and/or tools to support care of Acute Coronary Syndrome patients with diabetes.  CVHNS and DCPNS formed a joint working group to develop tools to support the identified needs. These resources include learning modules and specific standardized tools for healthcare providers to support inpatient teaching/education of acute care patients with a new diagnosis of diabetes, new diabetes treatment or in need of an update on diabetes. CVHNS has assisted local interdisciplinary working groups at each regional site to disseminate and implement the tools and resources locally.


Heart Failure

As part of the Provincial Clinical Documentation Standards work under Nova Scotia’s Model of Care Initiative, CVHNS facilitated the development of heart failure clinical documentation standards.  The intent is to ensure consistent documentation of minimum care for heart failure patients across the province and to guide paper and electronic documentation. A small group of experts developed the document and stakeholders from across the province were engaged to review the standards. 
CVHNS is partnering with the Maritime Research Network for Family Practice, using the Canadian Primary Care Sentinel Surveillance Network methodology to build a case definition/algorithm to identify heart failure in primary care electronic medical records.   The goal is to be able to learn more about the care and treatment of this population in Nova Scotia and compare to practices across the country.   If successful this can be rolled out nationally through the Canadian Primary Care Sentinel Surveillance Network.

Joint Initiatives


“Come on Nova Scotia… Check It!”, Blood Pressure Challenge 
The Come on Nova Scotia… Check It! Blood Pressure Challenge is a province-wide challenge that aims to increase awareness of the importance of knowing your blood pressure.  The challenge is held annually in the month of May, in honor of World Hypertension Day.  This campaign encourages Nova Scotian’s to have their blood pressures checked, learn more about blood pressure and use our provincial My Blood Pressure Tools which includes a wallet card and pamphlet. Tools and resources to implement the challenge are distributed at no cost to local community organizations, businesses and health care providers so groups can organize blood pressure screening and education.  To date, over 9000 blood pressures have been screened as part of the challenge. 

Dysphagia Screening, Assessment and Management
In partnership with Nova Scotia Hearing and Speech Centres (NSHSC), CVHNS has completed a number of initiatives to improve dysphagia screening, assessment, and management for stroke patients including:
  • coordinating and supporting training sessions on dysphagia assessment and management
  • facilitating consensus on a provincial swallow screening tool, and
  • facilitating changes in referral processes.
CVHNS and NSHSC will continue to develop strategies to support best practice across the province.
Provincial Protocol for Cardiac Catheterization in Patients with Renal Impairment 
In an audit coordinated by CVHNS, impaired renal status was found to be one of the key reasons that patients were not referred for cardiac catheterization.  CVHNS and the Nova Scotia Renal Program (NSRP) brought together a group of stakeholders to develop a protocol for preparation and follow up of this population for cardiac catheterization.  The group included representatives from interventional cardiology, internal medicine, nephrology and radiology from around the province.  The final protocol has been disseminated; the provincial PPO committee is currently reviewing a standardized preprinted order to assist with implementation around the province.