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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

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Update on Planning Stroke Services in Ireland

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  1. Update on Planning Stroke Services in Ireland Dr. Emer Shelley Population Health Directorate HSE East & Fionnuala O’Brien, HSE MidWest

  2. 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

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

  4. April 2008

  5. 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.

  6. 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 CVD Health Policy Group

  7. Service Planning and Development

  8. 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).

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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!

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