Acute Stroke

Act F.A.S.T. – A community led approach to improving stroke outcomes presentation here.

An evaluation of the 'Impact of the national public 'F.A.S.T' campaigns' has been published in the New Zealand Medical Journal here.

To order New Zealand F.A.S.T awareness resources contact the New Zealand Stroke Foundation.

The four Regional Acute Stroke Destination Policies were updated in 2020.

The National Stroke Clot Retrieval Service Improvement programme

Telehealth is the delivery of care across a distance via information and communication technologies. Telehealth can be used to provide rehabilitation (TeleRehab). Just like in-person rehabilitation, TeleRehab can include:

• subjective interview

• patient assessment

• goal setting, and

• individualised exercises and rehabilitation tasks.

The purpose of this National Working Group is to develop and implement a strategy that supports provision of a stroke thrombolysis service in all large and medium sized DHBs using clearly documented protocols and quality assurance measures.

For small DHBs it is expected a thrombolysis service is provided or a timely, effective pathway to access a service elsewhere.

Transient Ischaemic Attacks or TIAs (warning strokes or mini-strokes)

A TIA is the same as a stroke, except that the signs last for a short amount of time and no longer than 24 hours.

Although the signs do not last long, a TIA is very serious. It means there is a problem linked with a high risk of stroke. More than one in 12 people will have a stroke within a week after a TIA.

Because of this, a TIA is often called a warning stroke or mini-stroke. It shouldn’t be ignored. Read more

Stroke and TIA clinical update Professor Alan Barber and Professor Valery Feigin present clinical updates on stroke and TIA, and look at some relevant clinical cases. They also present on the Auckland Regional Community Outcomes of Stroke (ARCOS) studies that have helped our understanding of stroke. Learn more

• Stroke Thrombolysis

• Rapid TIA Access

• Acute Stroke Care

• Early Stroke Rehabilitation

Designated to stroke (not necessarily designated to stroke exclusively):

• A stroke physician*

• A stroke nurse*

• Physiotherapist

• Occupational Therapist

• Speech and Language Therapist

• Social worker

Clinicians that add significant value to stroke care, but are not mandatory designated members of the acute stroke team:

• Dietician

• Clinical Psychologist

• Pharmacist

* Each centre should have a designated lead stroke physician and lead stroke nurse. However, for daily clinical activities several clinicians can share patient responsibilities on a rotating basis.

• Baseline qualifications yet to be defined.

• Ongoing education should include a minimum of 8 hours of annual formal stroke education for each designated acute stroke team member

• Provision of education to other staff working with stroke

• Minimum IDT meeting once a week to discuss ongoing management, goal setting, and discharge planning

• Thrombolysis, TIA, stroke care guidelines (medical, nursing, dysphagia, early mobilisation, functional assessments, education of patients and family)

• If providing stroke thrombolysis maintenance of a thrombolysis registry is mandatory; additional stroke registry data is desirable although regular stroke relevant audits are an acceptable alternative. All serious adverse events should be fully investigated and discussed as a team.

• There should be some evidence that the service engages in clinical stroke research or stroke audits and patient advocacy relating to stroke.

Hospitals designated as providing an ‘Organised Acute Stroke Service’ should have a designated geographical area with stroke patients spending the majority of their acute hospital stay in this ‘unit.’ Ideally beds are dedicated to stroke patients, but this is not mandatory. In small hospitals where a dedicated ‘unit’ may not be feasible due to low patient volumes patients may be admitted to a single general medical ward if all other components of an organised stroke services are provided. Alternatively, if organised acute stroke services are not available patients should be transferred to a larger centre using a defined pathway. Formalised remote support from a larger service may in some instances be a further option.

Exact FTE allocation for interdisciplinary stroke team member staffing levels has not been firmly established at this point in time. However, as a general guide staffing levels should be sufficient to enable care of patients in accordance with NZ Stroke Guidelines. All designated members of the stroke team should have some dedicated time (part- or fulltime depending on patient volumes) specifically allocated to stroke care and maintenance of stroke care competencies.