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Stroke and Brain Injury Early Supported Discharge and Stroke Community Rehab Program   at
Medicine Hat Regional Hospital
Specialty: Rehabilitation
Connect Care Department: MED MHRH STROKE ESD
Estimated time to routine appointment: Within 1 week
Alberta Health Services - South Zone
SERVICE DESCRIPTION
In-home, intensive therapy (1 1/2 - 3 hours daily) offered to mild-moderate stroke and brain injury survivors to assist them in their recovery immediately after their event, hospitalization and/or when at risk of requiring increased care needs (early supported discharge). Community rehabilitation is reserved strictly for stroke survivors who cannot tolerate intensive rehabilitation (1 1/2 - 3 hours daily).In both programs, clients actively participate in setting goals for their therapy, which may continue up to 8 weeks. The ESD clinicians also provide support with overcoming barriers, reintegration within the community and transfer of care to outpatient rehabilitation and/or community services for continued support, when needed and available in the local area.
In-home, intensive therapy (1 1/2 - 3 hours daily) offered to mild-moderate stroke and brain injury survivors to assist them in their recovery immediately after their event, hospitalization and/or when at risk of requiring increased care needs (early supported discharge). Community rehabilitation is reserved strictly for stroke survivors who cannot tolerate intensive rehabilitation (1 1/2 - 3 hours daily).In both programs, clients actively participate in setting goals for their therapy, which may continue up to 8 weeks. The ESD clinicians also provide support with overcoming barriers, reintegration within the community and transfer of care to outpatient rehabilitation and/or community services for continued support, when needed and available in the local area.
ELIGIBILITY REQUIREMENTS
Stroke Early Supported Discharge (ESD) and Stroke Community Rehabilitation (SCR) Eligibility

ESD: minimum of 5 days/week 1.5 hours/day
SCR: minimum of 3 days/week, 1 hour/day
(Sessions may be split within the day to meet client's needs)
- Must have confirmed diagnosis of Mild to Moderate Stroke.
- Medically stable and safe to discharge home. Medical needs can be supported by home care or family.
· Tolerates and is willing to participate in therapy 3-5 days per week, Monday-Friday.
· Able to create rehab goals with team, family and/or caregiver support.
· Able to transfer and/or mobilize independently or with 1 person assistance.
- Lives within 1 hours of city limits.
Brain Injury ESD Eligibility 
- Must have confirmed diagnosis of an acquired brain injury resulting in mild to moderate disability.
· Medically stable and safe to discharge home. Medical needs can be supported by home care or family.
· Tolerates and is willing to participate in therapy 3-5 days per week, Monday-Friday.
· Cognitively able to participate and demonstrate carryover from session to session.
· Able to create rehab goals with team, family and/or caregiver support.
· Has support from caregiver(s).
· Able to transfer and/or mobilize independently or with 1 person assistance.
· Lives within one hour of the city limits

NOTE: only early supported discharge is available for traumatic brain injury conditions with this team. Community Rehabilitation category is reserved only for stroke survivors.
Stroke Early Supported Discharge (ESD) and Stroke Community Rehabilitation (SCR) Eligibility

ESD: minimum of 5 days/week 1.5 hours/day
SCR: minimum of 3 days/week, 1 hour/day
(Sessions may be split within the day to meet client's needs)
- Must have confirmed diagnosis of Mild to Moderate Stroke.
- Medically stable and safe to discharge home. Medical needs can be supported by home care or family.
· Tolerates and is willing to participate in therapy 3-5 days per week, Monday-Friday.
· Able to create rehab goals with team, family and/or caregiver support.
· Able to transfer and/or mobilize independently or with 1 person assistance.
- Lives within 1 hours of city limits.
Brain Injury ESD Eligibility 
- Must have confirmed diagnosis of an acquired brain injury resulting in mild to moderate disability.
· Medically stable and safe to discharge home. Medical needs can be supported by home care or family.
· Tolerates and is willing to participate in therapy 3-5 days per week, Monday-Friday.
· Cognitively able to participate and demonstrate carryover from session to session.
· Able to create rehab goals with team, family and/or caregiver support.
· Has support from caregiver(s).
· Able to transfer and/or mobilize independently or with 1 person assistance.
· Lives within one hour of the city limits

NOTE: only early supported discharge is available for traumatic brain injury conditions with this team. Community Rehabilitation category is reserved only for stroke survivors.
Referral instructions for primary care, community care, private
providers etc. who do not send referrals via Connect Care.
REFERRAL PROCESS - FOR NON-CONNECT CARE USERS
Complete the referral form and fax it to the service using the contact information in this profile.
Complete the referral form and fax it to the service using the contact information in this profile.
REFERRAL PROCESS - FOR CONNECT CARE USERS
Send an Internal Referral using the Ambulatory Referral Order to Rehabilitation, type MED MHRH STROKE ESD in the “To Department” section and complete order.
Send an Internal Referral using the Ambulatory Referral Order to Rehabilitation, type MED MHRH STROKE ESD in the “To Department” section and complete order.
REFERRAL PROCESS - FOR SELF-REFERRAL
Clients can self-refer by calling the service directly using the contact information in this profile.
Clients can self-refer by calling the service directly using the contact information in this profile.
COMMUNICATION PROCESS
  • Referral receipt to referring source within 7 days.
  • Acceptance via appointment details or wait list status letter to referring source and patient within 14 days.
  • Appointment outcome to referral source within 30 days.
 
PHONE
403-502-8648 Ext 1297
FAX
403-529-8021
REFERRAL PHONE
403-502-8648 ext 1297
REFERRAL FAX
403-529-8021
LINKED SPECIALISTS
CLICK + TO VIEW REFERRAL GUIDELINES
+-
Routine Reason for Referral
Access Targets convey the clinically appropriate timeframe patients should be seen within, by reason for referral and priority level.
Access Target
Required Information/Investigations
Investigation Timing
Additional Details
+-
Cerebrovascular accident
Medication List (dose, frequency, route)
 
Within 1 month
Past medical history
 
Within 1 month
Multidisciplinary teams including OT, PT, RT, SLP, SW, RN
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Stroke rehabilitation
Medication List (dose, frequency, route)
 
Within 1 month
Past medical history
 
Within 1 month
Multidisciplinary teams including OT, PT, RT, SLP, SW, RN
+-
Traumatic brain injury
Medication List (dose, frequency, route)
 
Within 1 month
Past medical history
 
Within 1 month
Multidisciplinary teams including OT, PT, RT, SLP, SW, RN
PATIENT APPOINTMENT INFORMATION
Email
Print
 
MISSED APPOINTMENT GUIDELINES
Should a client should miss 3 or more appointments a new referral may be required.
Should a client should miss 3 or more appointments a new referral may be required.
 
HOURS OF OPERATION
Monday: 8:00 am - 4:15 pm
Tuesday: 8:00 am - 4:15 pm
Wednesday: 8:00 am - 4:15 pm
Thursday: 8:00 am - 4:15 pm
Friday: 8:00 am - 4:15 pm
   
 
ADDRESS
666 5 Street SW
Medicine Hat Alberta
T1A 4H6
PATIENT APPOINTMENT INSTRUCTIONS
 
DIRECTIONS
Offices located in hospital however services are provided in the Community.
Offices located in hospital however services are provided in the Community.
 
PHONE
403-502-8648 Ext 1297
 
PARKING INSTRUCTIONS
Parking is available on site.
Parking is available on site.
 
EMAIL
VIRTUAL APPOINTMENT INFORMATION
 
 
WHEELCHAIR ACCESSIBILITY
Yes

The primary purpose of the All Locations list is to let the user easily access any location of a healthcare service without going back to the main search screen.

The locations listed have 3 background colors:
  • Green means the healthcare service@location has referral information attached to it.
  • Brown means the healthcare service@location never had referral information attached to it, or it has unpublished referral information.
  • Red means
    • IA changed the healthcare service@location's status to something other than Current
    • It was deleted if it is an ARD healthcare service@location.
Green  and Brown are always at the top of the list. These are the Healthcare Service@Locations with the status of Current.
The Red list at the bottom consists of non-current Healthcare Service@locations that once had Published referral information in the ARD.
If the referral information was never published in ARD the Healthcare Service@location will not show in the Red list.

The secondary purpose of the All Locations list is to allow ARD Administrators to recover (copy) referral information from the non-current Healthcare Service@Locations to ones that are current.

Common Scenario:
A Healthcare Service moves from one location to another. In this case the IA Healthcare Service@Location record will be made defunct (non-current) and a new Healthcare Service@Location record will be created with a current status. In this scenario the captured referral guidelines in ARD can become "orphaned" as they are not attached to any current IA healthcare service.

Categories of non-current or orphaned referral guidelines: INDIVIDUAL and COMMON.
The REFERRAL GUIDELINES section of the profile has the prefix INDIVIDUAL or COMMON to help you choose the method below when transferring referral guidelines from a non-current Healthcare Service@Location to a current healthcare service@location.

Individual referral process
  1. Click on a non-current (Red) Healthcare Service@Location at the bottom of the All Locations list.
  2. The non-current referral info is displayed with the link Copy this Referral Process to another Healthcare Service@Location link on the upper right hand corner. Click on the copy link.
  3. Choose a current location (Green or Brown) from the All Locations list. This will be the Healthcare Service@Location you are pasting the referral info into.
  4. The system will display the Edit Referral Info screen populated with the referral info from the non-current Healthcare Service@Location you viewed in the first step.
  5. Click Save and the referral info is transferred from the non-current Healthcare Service@Location to the current one.
  6. Repeat these steps for each Healthcare Service@Location that needs attention.

Common referral process - 2 sub cases.
Case 1: At least 1 current Healthcare Service@Location with common referral info is with current status for this healthcare service; One or more Healthcare Healthcare Service@Locations where replaced by new one.
  1. Click on any current Healthcare Service@Location whether it has referral info (Green) or not (Brown).
  2. The healthcare service location opens in the Edit Referral Info screen populated with the current common referral info.
  3. Save it. 
  4. All locations will be updated with the common referral information, including all the locations that don't have referral info yet (Brown). The non-current referrals (Red) will also be updated.
Case 2:  All Healthcare Healthcare Service@Locations for a healthcare service are set to a non-current status and replaced by new ones. In this case there is no current additional referral info to copy from, so the only alternative is to pick up the non-current common referral process (Red). Follow the steps described in the section Individual Referral Process above to copy/paste the non-current common referral info to the current healthcare service locations.
Generally we want to replicate current common referral info to new or replaced healthcare service locations. We only resort to copying non-current common referral info if there is no other option.

Remember: Some fields can be location specific with the common referral process:
Parking Instructions, Directions, Parking Map, Wait Time, Referral Phone or Referral Fax.
To update these items you have to edit each Healthcare Service@Location separately.

ADDITONAL NOTES:
  • The info icon after the All Locations drop down will be visible to ARD Administrators.
  • The system doesn't allow you to copy referral information from one non-current Healthcare Service@Location to another.

 

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