Transforming stroke care – the irish national stroke programme

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 n 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%