Page 58 - Regional Services Plan 2016/19

2.10 Midland Stroke Group
Chair: Peter Wright, Neurologist, Waikato DHB Project Manager: Kerry-Ann Adlam Lead Chief Executive: TBC
Context and vision:
Stroke affects approximately 160 people per 100,000 populations per year across our region (an estimated 1200 people). Of these approximately one in three die because of the stroke, and another one in three are significantly disabled requiring inpatient rehabilitation. Many of the remainder are left with some more mild disability. Stroke is the leading cause of adult disability in New Zealand. In general stroke admission rates across New Zealand are increasing (more than 5% over the last 4 years, and in those age 45-65 it has increased by 12% over 4 years). The stroke admission rates in Māori have risen two and a half times faster than in other ethnicities over this time, and Māori have been shown to suffer stroke about 10 years younger than other ethnicities. These changes likely represent both our aging population and an increasing risk factor burden in our younger adult population.
The Midland Stroke Network has a continued focus to reduce the impact of stroke on the residents of Midland DHBs. This means providing timely and accessible high-quality stroke services within the hospital setting. It also means that those affected by stroke receive timely, adequate and appropriate patient-focused rehabilitation in the acute and post discharge periods (includes social support services). Strengthening the primary prevention message and encouraging Māori to access TIA and stroke services are also priorities.
Regional Objectives
 To improve primary and secondary stroke prevention and reduce stroke related disability and mortality.
 To improve access to quality assured organised acute, rehabilitation, and community stroke services.
 To ensure all stroke patients have access to high-quality stroke services regardless of age, gender, ethnicity or geographic domicile.
Develop and deliver a regional plan for stroke services supporting the continued implementation of best practice stroke care, ensuring equitable access is provided to all New Zealanders. This should be consistent with the New Zealand Clinical Guidelines for Stroke Management 2010 (the Stroke Guidelines) and include advice provided by the national and regional stroke networks. This will include the following.
Organisation of stroke services
 People with stroke admitted to hospital are treated in a stroke unit and/or in the setting of an organised stroke service (see PP20 for definitions of a stroke unit and organised stroke services).
Thrombolysis
 All people with stroke have access to a quality assured thrombolysis service 24/7 (eg, this will include the development of regional plans to provide remote support via Telestroke).
Rehabilitation
 All eligible people with stroke receive early active rehabilitation services (as defined by the National Stroke Network), supported by an interdisciplinary stroke team.
 All eligible people with stroke have equitable access to community stroke services. Education, training and audit
 All members of the interdisciplinary stroke team participate in ongoing education, training and quality assurance and service improvement
programmes according to the Stroke Guidelines, and as recommended by the national and regional stroke networks.
Workforce
 A regional workforce plan that supports the delivery and achievement of sustained, consistent and safe thrombolysis, and comprehensive evidence-based interdisciplinary acute and rehabilitation stroke care provision.
 Identified actions that the region will take to develop and implement an ongoing education programme that supports a sustainable and high-quality clinical workforce.
Information Technology
 Identified actions that the region will take to support improved information management, eg, establishing a regional oversight role. To achieve the regional objectives requires
 The Midland region to have and maintain a lead stroke nurse and lead stroke physician
 Active clinical membership and participation into regional network activity
 That Midland DHBs work collaboratively with regional ambulance service to ensure timely access to thrombolysis,
 That advice from the National Stroke Network is fed into the regional network,
 That accurate and timely collection of data occurs so the region can report monthly and
 That quarterly measures are monitored.
Measures
Use the three DHB Annual Plan measures to identify gaps and opportunities for development of regional models of care.
 6 percent or more of potentially eligible stroke patients thrombolysed 24/7 (see PP20 for definition of ‘eligible’)
 80 percent of stroke patients admitted to a stroke unit or organised stroke service (see PP20 for definitions).
 80 percent of patients admitted with acute stroke who are transferred to inpatient rehabilitation services are transferred within 7 days of
acute admission (also report percent of acute stroke patients transferred to inpatient rehab). Notes:
 Service activity information will routinely be presented by ethnic population groups and (where possible) by urban/ semi-urban, rural settings to allow the monitoring of inequalities to occur as well as the closing of any gaps over time.
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INITIATIVES OF REGIONAL NETWORKS AND CLINICAL ACTION GROUPS