Stroke Services

Integrated stroke care is a specialized service that requires specific expertise and resources, and a critical mass of patients to sustain these services.  It also requires coordination of care that relies on coherence with other care programs and services. The Ministry of Health has made integrated care a priority, as a result, the Toronto Stroke Networks are driven to prioritize this approach in our work. 

We persist in our efforts to create a sustainable model for stroke care delivery with enhanced accountabilities while ensuring the following:

• Understanding the demand for stroke services
• Creating a system that responds to the needs of the population
• Recognizing the importance of community teams
• Planning aligns with stroke as a specialized service

For further information on integrated stroke care as a specialized service, click here

Emergency Stroke Management

To ensure access to stroke best practices, Ontario paramedics and hospitals have worked together to bring persons with stroke symptoms directly to one of three Regional Stroke Centres (RSCs) by bypassing community hospitals.  

The three RSCs in Toronto are:

St. Michael’s Hospital (SMH), Unity Health Toronto
A Regional Stroke Centre within the South East Toronto stroke network region.
30 Bond St, 14th floor Cardinal Carter Wing
Toronto, Ontario, M5B 1W8

Sunnybrook Health Sciences Centre (SHSC)
A Regional Stroke Centre within the North & East GTA stroke network region.
2075 Bayview Avenue
5th Floor, D Wing, Room D5-81
Toronto, Ontario, M4N 3M5

Toronto Western Hospital (TWH), University Health Network
A Regional Stroke Centre within the Toronto West stroke network region.
399 Bathurst Street
5th Floor, West Wing, Room 425
Toronto, Ontario, M5T 2S8

RSCs can deliver when appropriate, the following specialized hyperacute care:

• Thrombolysis: is the process of using medications (i.e., tissue plasminogen activator, tenecteplase) to breakdown blood clots formed in blood vessels
• Endovascular treatment (EVT): involves the mechanical removal of a blood clot within a large vessel (artery) of the brain*

As well, the RSCs offer pre-hospital, emergency, acute, and secondary stroke prevention services.  Patients that are not eligible for thrombolysis, EVT and/or no longer require the services of the RSC will be repatriated (transferred) to a community acute hospital closest to home, if ongoing medical care is required.  A brochure for patients/family members/caregivers explaining the process is available in:

*Retrieved from CorHealth on October 4, 2023

Within the TSNs, acute stroke care is provided in the following organizations:

• Humber River Health
• Michael Garron Hospital
• North York General Hospital 
• Scarborough Health Network, Birchmount Hospital (integrated stroke unit)
• St. Joseph’s Health Centre, Unity Health Toronto
• St. Michael’s Hospital, Unity Health Toronto
• Sunnybrook Health Sciences Centre
• Toronto Western Hospital, University Health Network

A new Ontario Stroke Unit definition was launched in June 2023.  The definition continues to be grounded in the Canadian Stroke Best Practice Recommendations and was updated based on stakeholder feedback and the expertise of the Provincial Stroke Unit Task Group.

New Definition:

“A stroke unit is a specialized unit dedicated to the care of persons with stroke and staffed by an experienced, interprofessional stroke team. The unit has designated stroke unit beds that are co-located and in physical proximity to each other. These beds are used to provide care for stroke patients most of the time”. (Ontario Health – CorHealth, 2023)

The intention is to promote consistent understanding and reduce variation in how stroke units are operationalized as a first step in reducing inequities to this best practice.

The TSNs are committed to supporting organizations in understanding and developing their own individually tailored plan to meet the new provincial definition.

The Benefits of Acute Stroke Unit Care:

• Access to a dedicated interprofessional team with stroke expertise in clinical nutrition, medicine (neurology and general internal medicine), nursing, occupational therapy, pharmacy, physiotherapy, social work, and speech-language pathology.
• Specialized assessment skills and training to facilitate improved stroke recovery.
• Early assessment and initiation of therapy to get patients moving and begin early rehabilitation.
• Improved patient outcomes by reducing mortality and disability.
• More timely intervention.
• Timely transfer to rehabilitation as appropriate.

The West GTA Stroke Network and the Toronto Stroke Networks have collaborated to create a video highlighting the importance of stroke unit care.

The Hospital for Sick Children (SickKids) - Pediatric Stroke Program

The SickKids Pediatric Stroke program remains a world leader in multidisciplinary innovative and collaborative care for children with stroke.  Collaborations with neurosurgery, neurocritical care, thrombosis, genetics and neuroradiology remain strong and foundational for novel therapies such as intra-arterial thrombolysis and refined diagnostics such as arterial wall imaging and cerebrovascular reactivity magnetic resonance imaging.  For more information about this program, click here.

Stroke rehabilitation helps people with stroke re-learn skills or learn how to complete a new task. Rehabilitation experts agree that it is important that stroke rehabilitation is goal-directed, focused, and includes novel and repetitive practice.

Stroke rehabilitation starts in acute care (hospital), usually within the first 24-48 hours of getting to the hospital.  Rehabilitation can continue in many different places, such as inpatient rehabilitation, outpatient rehabilitation, or community settings.  The length of time in rehabilitation programs is dependent on many factors, such as stroke severity and home supports.  Stroke rehabilitation can include assessment and treatment by an interprofessional team made up of: Clinical Nutrition, Medicine, Nursing, Occupational Therapy, Pharmacy, Physical Therapy, Psychology, Recreational Therapy, Social Work, and Speech-Language Pathology.

Within the Toronto Stroke Networks, stroke rehabilitation is provided in the following organizations:

• Hennick Bridgepoint Active Healthcare, Sinai Health System
• Providence Healthcare, Unity Health Toronto
• Scarborough Health Network, Birchmount (integrated stroke unit), Community Neurorehab Clinic (outpatient rehabilitation)
• St. John’s Rehab, Sunnybrook Health Sciences Centre
• Toronto Rehab, University Health Network
• West Park Healthcare Centre

For more information about stroke services within the Greater Toronto Area (GTA), click on the links above.  Information can also be found on the GTA Rehab Finder website.

eStroke Rehab Referral System in RM&R

Within Toronto, acute care hospitals are able to send referrals to inpatient and outpatient rehabilitation programs through the eStroke Rehab Referral System (eStroke) in RM&R.  eStroke tracks demand, wait times, response times, acute and rehab facility indicators that measure and evaluate access and system efficiency. It is used as a data source to drive and monitor system wide best practice implementation in stroke care. Approximately 600 eStroke users are registered in 17 facilities in the Toronto area.  It supports 3000+ referrals annually to stroke rehabilitation programs. For more information, email us at info@tostroke.com.

Secondary stroke prevention clinics service patients in the community who are at high-risk for stroke, and/or have had a transient ischemic attack (TIA), and/or a stroke.  These clinics offer early assessment, risk factor management, and follow-up to help prevent another stroke or TIA.

Below is a list of secondary stroke prevention clinics in Toronto.  Where available, a link to a referral form is included. 

Scarborough Health Network, Birchmount Hospital: Stroke Prevention Clinic
3030 Birchmount Rd, 4th floor
Scarborough, ON, M1W 3W3
Tel: 416-495-2558
Fax: 416-495-2581

Stroke Prevention Clinic Referral Form     Key Word: Stroke

Humber River Health: Stroke Prevention Clinic
1235 Wilson Avenue, 4th Floor Medical Clinics
Toronto, ON, M3M OB2
Tel: 416-242-1000, ext. 23400
Fax: 416-242-1094

Stroke Prevention Clinic Referral Form

North York General Hospital: Stroke Prevention Clinic
4001 Leslie Street, Ground Floor, Room GSE-140
Toronto, ON, M2K 1E1
Tel: 416-756-6545
Fax: 416-756-6567

At this time referrals are accepted only from the emergency department.

St. Michael’s Hospital – Unity Health Toronto: Stroke & Neurology Clinic
30 Bond Street, 6th Floor, Bond Wing
Toronto, ON, M5B 1W8
Tel: 416-864-5056
Fax: 416-864-5712

TIA and Stroke Prevention Referral Form

Sunnybrook Health Sciences Centre: North & East GTA Stroke Network Stroke Prevention Clinic
2075 Bayview Avenue, 4th Floor, A Wing, Room A-455
Toronto, ON, M4N 3M5
Tel: 416-480-4473 or 416-480-4866
Fax: 416-480-5753

Stroke Prevention Clinic Referral Form

Toronto Western Hospital – University Health Network: Stroke Prevention Clinic
399 Bathurst Street, 5th Floor, West Wing
Toronto, ON, M5T 2S8
Tel: 416-603-5413 (Contact: Tessie Mongit)

Stroke Prevention Clinic Referral Form

Community programs and services are available to support persons with stroke and their families/caregivers after discharge home from either an acute care or rehabilitation facility.  Access to these resources can be started by the referring hospital, primary care physician, or persons with stroke and their families/caregivers.  As there may be a cost associated with these services, ask about any extra costs that may not be covered by the Ontario Health Insurance Plan (OHIP). 

If you need help finding resources, please click here for details on the following: 

• Home and Community Care Support Services (HCCSS)

• Search Engines for community programs and services

• Stroke Support/Peer Support Groups

• Self-Management Virtual Groups

• Caregiver Support

• Additional Therapy and Exercise

• Mental Health Crisis Services

• Information and support for immigrants, newcomers and refugees

• Online technology support 

Primary care is the first point of contact between a patient and the health care system and includes illness prevention, health promotion, diagnosis, treatment and supports referrals to community resources and other medical professionals and services.

The importance of primary care in stroke prevention and care includes the following:

Primary Prevention:

• There is an urgent need to improve primary prevention of stroke and cardiovascular disease.
• More strokes can be prevented through the management of relevant cardiovascular risk factors.
• High quality primary care can influence the future of stroke burden around the world.
• The relationship primary care professionals foster with their patients will support their health and wellness through education and connection with community resources.

Secondary Prevention:

• Initial appointment with the primary care provider would ideally occur within the first month following hospital discharge.
• High quality primary care is required to manage new needs, prevent recurrence of stroke, help to prevent complications, optimize quality of life and facilitate prompt access to specialists as needed.
• Collaboration with Stroke Secondary Prevention Clinics is essential to provide seamless care and minimize duplication of service.
• Ongoing support of a patient's journey toward recovery through education and connection with stroke-specific community resources.

Need help finding a primary care physician or nurse practitioner follow this link:  https://www.ontario.ca/page/find-family-doctor-or-nurse-practitioner