Proof of Concept: Stroke Navigation in New Brunswick

• The transition from hospital to home post-stroke can be difficult for patients and family members. Some patients can experience difficulties self-managing their stroke, they could experience a secondary stroke, and/or become re-hospitalized. 
• This project aimed to learn if stroke navigation could benefit people with self-managing their stroke and prevent re-hospitalizations. 
• The Stroke Navigation Program provided information and resources to stroke patients on self-management after experiencing a stroke.  
• A Stroke Navigator was assigned to each participant, who used a post-stroke checklist to help identify the patients’ unique needs after being discharged from the hospital. The Navigator shared relevant resources with the participant and helped to refer them to needed services.  
• The participants were patients over the age of 65 who had a stroke and went through the Stroke Navigation Program. In total, there were 18 participants (9 male, 9 female).  

• After accessing the Stroke Navigation Program, patients improved on their self-rated survey measuring self-management post-stroke (e.g. improvements on medication understanding, and other general health measures). 
• Participants enjoyed and appreciated having access to Stroke Navigation and the Stroke Navigator services. Although there were no re-admissions 6-months post-stroke (n = 17), results should be cautiously interpreted as there was not enough data to know if this outcome was caused by the program’s success 
• Overall, the stroke navigation program was well received by participants. This style of patient support has potential to improve the wellbeing of patients who are discharged from hospital after stroke, but more research is needed to understand the impact of the program.  

This project recommends that if Stroke Navigation was to continue as a program: 

• Offer varied service delivery options (e.g. phone, online, in-person), as patients had different accessibility needs and preferences.  
• Continue to work with hospitals on their referral system to the Stroke Navigation Program. 
• Add Stroke Navigation to clinical order sets and discharge planning files. 
• Continue focusing on strategic communication and marketing efforts directed at the public. 
• Continue to evaluate Stroke Navigation to improve the program and its processes. 

To learn more read the complete project findings (PDF 155 KB)

• Stroke Navigation: How People Come Home After a Stroke With Beverly Kemp