National Stroke Services Audit useful to Wairarapa

National Stroke Services Audit useful to Wairarapa DHB

A recently released national audit has found New Zealanders do not have sufficient access to organised hospital stroke services. The audit also found some positives, including a better approach to the assessment of mini-strokes (TIA’s, or transient ischaemic attacks) here, than in Australia.

Funded by the Ministry of Health and carried out by the Stroke Foundation of New Zealand in 2009, the audit looked at the provision of stroke services in hospitals in the first seven days after stroke. Findings were compared with an audit of Australian hospital stroke services.

“We were glad to participate in this audit, and welcome the findings,” says Anna Reed, Clinical Nurse Specialist in Older Persons Health at Wairarapa Hospital. “We had a team of two of our doctors a nurse and an Occupational Therapist helping assess the processes we have in place, and the care given in the first 7 days of admission following a stroke.”

Stroke Foundation Chief Executive Mark Vivian says the audit provides a benchmark against which future developments and improvements can be compared. “With most strokes, the sooner you get to hospital and begin to be treated, the better your outcome.”

The audit found that 67 percent of DHBs offered time-critical intravenous treatment that breaks down blood clots if commenced within four and a half hours of stroke onset. Over 80 percent of New Zealanders live within a DHB area that offers this treatment. However, only 3 percent of stroke patients were actually receiving this time critical treatment, the same percentage as in Australia.

“TPA (thrombolyasis) is available in the Wairarapa, and 2 patients have been successfully thrombolysed in the past 12 months,” says Wairarapa Hospital physician Dr Tim Mathews. “This number could be higher, but many patients don’t report their symptoms to the hospital within the allocated time for thrombolytic therapy. There is a 3 hour window of opportunity from the onset of symptoms to thrombolyasis, and the patient also needs to meet all the medical criteria for this treatment.”

Dr Matthews & Dr Smith have been collaborating with Hawkes Bay DHB & are working regionally to have a defined policy on Thrombolyasis. Wairarapa Hospital already has a policy, but there are benefits in having regionally consistent management protocols. There is a meeting next week between Hutt, Hawkes Bay, MidCentral, Wanganui & Capital & Coast DHB's to progress this.

Mr Vivian from the Stroke Foundation says a positive highlighted by the audit was our assessment of transient ischaemic attacks (TIAs) or mini-strokes, with just over 80 percent of DHBs using a recognised assessment tool with TIA patients, compared with just under 40 percent of Australian hospitals.

“The DHB and PHO are working together to actively and aggressively manage stroke risk by monitoring & medical management of hypertension, cholesterol, Atrial Fibrillation and other risk factors,” says Dr Matthews. “There is a determined focus on diagnosis of TIA's (mini Strokes) by the GP's, who utilise the ABCD2 tool recommended in the audit. Any patient identified as being at high risk is fast-tracked for CT and Carotid scanning.”

“Stroke management is evolving rapidly, which is good news for our aging population,” says Clinical Nurse Specialist Anna Reed. “In recent times, we have started a Stroke Multidisciplinary Interest group which review stroke case-studies and reflects/acts on improving practice. On the national front, the Clinical Nurse Leader from ED and I are part of a very proactive Stroke Clinical Nurse Specialist group who are working with the Ministry of Health to promote & provide best practice Stroke Guidelines nationally. We are sharing assessment tools, policies and care-planning tools to promote a national pathway for stroke management.”

"We are on track to implement the report's recommendations,” says the Ministry of health’s Acting Deputy Director-General Sector Capability and Innovation Dr Ashley Bloomfield. “The Ministry of Health is currently working on updating the 2010 New Zealand Stroke Guideline, which sets out to identify international best practice guidelines for primary care and hospital services and make recommendations in order to provide the best quality care to stroke patients with organised stroke services ; and will discuss follow-up measurement with the Stroke Foundation."

It is hoped to repeat the audit next year.

Fact Box

The snapshot audit found:

• 8 out of 21 District Health Boards provide stroke services that are consistent with international best practice,
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• 39% of the patients in the audit received care in a stroke unit compared with 51%,in participating Australian hospitals.
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• New Zealand has 83 dedicated beds in stroke units - on the day of the audit there were 176 acute stroke patients in our hospitals.
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• more than half the audited stroke patients were aged over 77 years
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• 48 percent of patients were male and 52 percent female
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• ethnicity was recorded as Maori for 13 percent and Pacific for 3 percent
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• most of the patients had been independent prior to their stroke (66 percent), and 90 percent lived at home
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• three-quarters were diagnosed with an ischaemic stroke
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• half had multiple pre-existing stroke risk factors at the time of admission.
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The full report is available at: www.stroke.org.nz

ENDS

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