Transcript Update on Planning Stroke Services in Ireland

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 GROUP
Having 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 Noel Caplice
• Professor Hannah McGee (Chair)
• Ms Angela Fitzgerald
• Dr. Brian Gaffney
• Dr Siobhan Jennings
• Dr. Geoff King
• Ms Anna Marie Lanigan
• Dr. Brian Maurer
• Mr John Treacy
• Dr. Peter Crean
• Mr. Brian Mullen
• Professor Peter Kelly
• Ms Paula Mullin
• Dr. Eilis McGovern
• Dr John Devlin
• Dr. Mark Delargy
• Ms Sophie Charles
• Dr Tracey Cooper
• Dr Rónán Collins
• Ms Esther Freeman
• Professor Ivan Perry
• Professor Colin Bradley
• Dr Emer Shelley
Service Planning and
Development
Consultation
69 submissions were received:
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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, Dublin
St. James’s Dublin
South Tipp. General, Clonmel
Our Lady’s Hospital, Navan
Sligo 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 stroke
Collaboration essential
Ní neart go cur le chéile!