Update on Planning Stroke Services in Ireland

Dr. Emer Shelley

Population Health Directorate

HSE East

& Fionnuala O’Brien, HSE MidWest

Outline

• Trends in epidemiology• Stroke policy:

Department of Health and Children • Service developments:

emergency response & acute hospitals community services

• Guidelines • Review and Action Plan:

Health Services Executive

Allender S, Scarborough P, Pteo V, Rayner M.

European Heart Network, Feb 2008

April 2008

TERMS OF REFERENCE CARDIOVASCULAR HEALTH

POLICY GROUPHaving regard to the audit of the implementation of the cardiovascular health strategy ‘Building Healthier Hearts’ and the audit of stroke services ‘Irish National Audit of Stroke Care’, and consistent with developments in relation to the management of chronic diseases and the Primary Care Strategy, to develop a policy framework for the prevention, detection and treatment of cardiovascular disease, including stroke and peripheral vascular disease, which will ensure an integrated and quality assured approach in their management.

CVD Health Policy Group • Professor Hannah McGee (Chair)

• Dr. Brian Gaffney

• Dr. Geoff King

• Dr. Brian Maurer

• Dr. Peter Crean

• Professor Peter Kelly

• Dr. Eilis McGovern

• Dr. Mark Delargy

• Dr Tracey Cooper

• Ms Esther Freeman

• Professor Colin Bradley

• Professor Noel Caplice

• Ms Angela Fitzgerald

• Dr Siobhan Jennings

• Ms Anna Marie Lanigan

• Mr John Treacy

• Mr. Brian Mullen

• Ms Paula Mullin

• Dr John Devlin

• Ms Sophie Charles

• Dr Rónán Collins

• Professor Ivan Perry

• Dr Emer Shelley

Service Planning and Development

Consultation

69 submissions were received:

• people and families living with stroke (27)

• individual healthcare professionals (15)

• healthcare professional groups (11)

• patient representative groups (6)

• hospitals (7), and

• commercial companies (3).

Priority service developments in emergency care and acute hospitals

• Identify location for stroke unit, starting in supra-regional / regional hospital

• Agree on lead physician, team members and team meetings

• Guidelines• Training of emergency services staff

and upgrade stroke in dispatching system

Priority service developments in emergency care and acute hospitals

• Proposed to National Hospitals Office Management Team

• Discussed with manager of each hospital network

• In recent weeks the NHO has reviewed progress

Developments in Acute Hospitals; Acute Stroke Units

6 hospitals reported an acute stroke unit:Mater Misericordiae, DublinSt. James’s DublinSouth Tipp. General, ClonmelOur Lady’s Hospital, NavanSligo General & Portiuncula, Galway

2 gave date to open stroke unit:Connolly, Dublin (May) St. Luke’s Kilkenny (June)

Bantry also: ? date

Acute Stroke Beds

By June 2008

45 acute stroke beds plus those in Acute Medical Assessment Unit, St. James’s

Some units referred to rehab. beds in addition to the acute beds counted

3 hospitals said they cohorted patients to a specific ward

There were 411 stroke patients in acute hospitals when INASC did organisation audit, so scope for further allocation of acute beds for stroke

Thrombolysis

8 hospitals reported providing thrombolysis

1 provides on weekdays

1 hospital – to be clarified

CT available 27 / 36 hospitals

4 onsite daytime only; 1 half-time

MRI available 19 / 36; 2 have 2 days / week

Staff and Teamwork

21 hospitals: some evidence of teamwork

Specialist nurses: 7 + 1 in June+ 1 in training

Great variation in other professionals: some areas much better than others

Overall Picture: Hospitals

16 hospitals had acute stroke unit or definite plans within 3 months and / or provided thrombolysis and / or provided strong evidence of organised stroke service e.g. named consultant, team meetings, purchased equipment

Community Services• Developments of services will benefit

those with stroke

• 97 functioning primary care teams, including physiotherapy and speech and language therapy

• Improved acute services will reduce dependency and need for continuing care

• Guidelines for transition between care settings, including improved communications

Guidelines

• HSE has requested that Irish Heart Foundation Council on Stroke to agree guidelines for stroke care in Ireland

• HSE will make guidelines available on Health Intelligence website

• Investigating use of intranet for guideline development

Audit and Evaluation

• There are a number of hospital registers

• Need to agree data standards

• Support for development of registers in all acute settings, especially those providing thrombolysis

• Also linkage to community services

Summary and Action Plan

• There have been some service developments since INASC in mid-2006

• Use report of CVD Health Policy Group, consultation, available data and input from HSE services to develop Action Plan

• 1. emergency and acute care

• 2. rehabilitation and continuing care

Thank you to all who have input to date, especially the IHF, the Stroke Council and the INASC team

Continued advocacy for strokeCollaboration essential

Ní neart go cur le chéile!