Update on Planning Stroke Services in Ireland

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Update on Planning Stroke Services in Ireland

• Dr. Emer Shelley
• Population Health Directorate
• HSE East
• Fionnuala OBrien, HSE MidWest

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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

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Allender S, Scarborough P, Pteo V, Rayner M.
European Heart Network, Feb 2008
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April 2008
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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.

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CVD Health Policy Group

• 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

• 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

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Service Planning and Development
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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).

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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

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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

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Developments in Acute Hospitals Acute Stroke
Units

• 6 hospitals reported an acute stroke unit
• Mater Misericordiae, Dublin
• St. Jamess Dublin
• South Tipp. General, Clonmel
• Our Ladys Hospital, Navan
• Sligo General Portiuncula, Galway
• 2 gave date to open stroke unit
• Connolly, Dublin (May)
• St. Lukes Kilkenny (June)
• Bantry also ? date

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Acute Stroke Beds

• By June 2008
  
• 45 acute stroke beds
  plus those in Acute Medical
  Assessment Unit, St. Jamess
• 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

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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

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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

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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

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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

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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

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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

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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

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Thank you to all who have input to date,
especially the IHF, the Stroke Council and the
INASC teamContinued advocacy for
strokeCollaboration essentialNí neart go cur
le chéile!