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Transforming stroke care – the irish national stroke programme

Authors:

Rónán Collins ,

National Stroke Programme HSE, IE
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Joan McCormack,

National Stroke Programme HSE, IE
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Áine Carroll,

National Clinical & Integrated Care Programmes HSE Ireland; University College Dublin, IE
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Joe Harbison

National Stroke Programme HSE, IE
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Abstract

The first Irish National Audit of stroke care by the Irish Heart Foundation (IHF) in 2008 found only one hospital had an acute stroke unit, less than 1% stroke patients got thrombolysis and death from stroke was 19%. The Irish National Stroke Programme (NSP) was set up in 2010 to modernise stroke care in the country and reduce by one the death and disability from stroke each day, through the implementation of international  guidelines for management of stroke.

The programme appointed joint neurology and geriatric medicine clinical leads, a senior public health doctor and senior stroke nurse as programme manager.NSP produced a Model of Care identifying five key areas for development: Prevention; Emergency Stroke Care; Acute Stroke Unit Care; Community Stroke Care and a stroke register.

The NSP established the National Stroke Register (NSR) ,an essential tool to measure  effect of implementation of the Model of Care;providing data for planning and resource requirements for individual &national stroke services, evaluation and clinical audits..The programme  identified three national KPIs 1) 90% of acute stroke patients admitted to a stroke unit; 2) stroke patients to spend 90% of LOS in a stroke unit;3) a national thrombolysis rate of 12%.

The KPIs were agreed nationally by  Health service Executive  and circulated to all hospital managers. The Stroke Programme identified clinical leads and supported a gap analysis in each acute hospital regarding acute stroke unit care and ability to deliver 24/7delivery of thrombolysis. Through this process key staff vacancies were prioritised and innovative solutions to 24/7 senior assessment ,like telemedicine piloted and supported

In 2015 the second Irish National Audit on stroke confirmed the significant progress of the stroke programme whereby 21/27 acute hospitals now had an acute stroke unit and there was better processes of stroke care (Table 1 & 3). The national stroke register also showed significant improvement in KPIs where currently 69.2% of patients are admitted to an acute stroke unit and 11.8 % of patients received intravenous thrombolysis (Table 2). Both the independent IHF audit and national stroke audit also identified ongoing clinical challenges around care of swallow and mood assessment following stroke.

The National Stroke Programme has now embarked on writing a funded pragmatic 5 year strategy  to ‘make big stroke history’ with a focus on embedding recent high impact medical advances in the key areas of our stroke services  ‘acute care and cure’, ‘Prevention’ , ‘restoration to living’ and ‘research and education.’

Table 1 : Irish Heart Foundation Stroke Audits

                          IHF National Stroke Audit 2008                      IHF National Stroke Audit 2015

Mortality                       19%                                                                   14%

Stroke Units                    1%                                                                   85%

CT Scanning 24/7          84%                                                                100%

Clinlead for Stroke        32%                                                                 85%

Nurse Specialist              14%                                                                85%

Table 2: National stroke Register & KPIs

National KPI s for stroke               2013 NSR                                       2017 NSR

1. Admission to stroke unit              64.1%                                               69.2%

2. >90% of LOS in stroke unit         57.2%                                               70.4%

3.Thrombolysis                                  11.3                                                  11.8%

Table 3 Processes of care in natiobnal stroke audits  and regsiter

                                                Stroke Audit 2008      Stroke Audit 2015       NSR 2017

Swallow Screening                       26%                          29%                          66%

Mood Assessment                        28%                          33%                           33%

Aspirin within 48hrs                    49%*                        70%                           76%

How to Cite: Collins R, McCormack J, Carroll Á, Harbison J. Transforming stroke care – the irish national stroke programme. International Journal of Integrated Care. 2019;19(4):382. DOI: http://doi.org/10.5334/ijic.s3382
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Published on 08 Aug 2019.

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