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National Stroke Network Newsletter - October 2018

Welcome to the National Stroke Network Newsletter!

National Stroke Network - announces new chairperson

We are pleased to welcome Dr Alan Davis, stroke physician from Northland DHB to the role of Chair of the National Stroke Network.  Alan has taken over the reins from A/Prof Anna Ranta who has stepped down to take on a position with the Ministry of Health as Clinical Director for the new National Stroke Clot Retrieval Service Improvement Programme.  Anna remains chair of the Central Region Stroke Steering Group and continues to manage the Thrombolysis Register.

 

Reflections on the 2017/18 year for the National Stroke Network by outgoing chair A/Prof Anna Ranta

I am pleased to report that 2017/18 has been another busy year with lots of activity and achievements on the New Zealand stroke front. We kicked off the year with a successful Stroke Society of Australasia Conference held in Queenstown – the first time in New Zealand in over ten years.  Many of you attended and we made an impression on our Australian colleagues who have agreed to hold the SSA meeting in New Zealand every five years going forward.

Next were the release of the new Clinical Guidelines for Stroke Management 2017 https://informme.org.au/Guidelines/Clinical-Guidelines-for-Stroke-Management-2017. This effort was led by the Australian Stroke Foundation/stroke clinicians with active input from NSN members and others from the New Zealand stroke community.  These new guidelines replace the 2010 New Zealand Stroke Guideline except for chapters specific to New Zealanders including Māori and Pacific Islanders. 

Early in the year we finally received approval to be a bit more open with DHB data sharing and benchmarking both around the thrombolysis register as well as AROC data to measure stroke rehabilitation outcomes.  It was great to see all 20 DHB CEOs support and sign our request for increased sharing. Collectivised this data underpins our Annual Data and Quality Meetings and other monitoring activities at regional and national levels, which in turn drive service improvement across the country.  The Quality days were once again well attended and feedback indicates that people would like us to repeat these.  The 2019 Quality Meetings will be held on 6 & 7 June in Wellington.

On the rehabilitation front we have now fully implemented the fourth national stroke indicator which measures the time to community rehabilitation following hospital discharge.  Data for this one is a bit harder to capture than others, but each quarter more and more DHBs are including this information in their reports.  It is clear from this data that we still have quite a lot of work to do in that space and it is therefore very timely that we are continuing to invest extra resources in advancing stroke rehabilitation work. 

Last year we achieved funding support to commission a proposal for a NSN stroke rehabilitation strategy and Drs Geoff Green and Mo Maddula, with input from the Rehab Working Group, have been working hard to produce a fantastic document.  This is currently undergoing final edits following consideration by the NSN.  This current financial year there has been a shift of more resource into project management support to help facilitate the implementation of the recommendations from the stroke rehabilitation strategy.  We are pleased that Ginny Abernethy has taken up this new role and a new NSN administrator has recently been appointed.  While I was unsuccessful in my attempts to secure funding support for a dedicated stroke rehabilitation clinical leadership position the transition from myself to Alan Davis as NSN chair will hopefully address this gap.

Another initiative has been work around setting stroke service credentialing criteria, which are now completed for the acute services, but require further consideration for stroke rehabilitation and community services. 

On the acute front a big achievement this year has been the transition of the National Stroke Thrombolysis Register to the new REDCap platform, which has improved data collection, visibility, and reporting.  This is still a work in progress, but we are getting there! 

A further acute space achievement has been the approval by the Ministry of Health to establish a National Stroke Clot Retrieval Service Improvement Programme.  This was borne out of the significant challenges we face in achieving equitable access to this highly effective but also very complex stroke treatment.  More than any other stroke treatments these services will require strong regional and super-regional collaboration and coordination to be successful and thus direct national level ministerial oversight and facilitation was felt to be important to ensure success within reasonable time frames.

Finally, the NSN has worked to establish a new Stroke Society of Australasia – New Zealand (SSA-NZ) Division that will cater specifically to the needs of stroke professionals such as clinicians and researchers in New Zealand.  An inaugural executive has been formed and a call for EOIs to join the committee is included below.  On this note I would like to encourage all of you to consider joining the SSA (http://www.strokesociety.com.au), which (if you are NZ based) automatically makes you a member of SSA-NZ.  The more members we get the stronger and effective our professional network will become and the better we can advocate for things like regular SSA meetings held in New Zealand and other professional opportunity to improve the care for our patients. 

In closing, my term as National Clinical Leader, Stroke, and chair of the National Stroke Network has come to an end and I would like to take this opportunity to thank all of you for your support and collaboration to further the work of the NSN and stroke care across NZ in general.  It has been an extraordinary privilege to serve in these roles and I hope I have contributed a little bit to the improvement of stroke service provision during my tenure.  I am not going far and look forward to ongoing collaboration with all of you who share my passion for caring for people with stroke.

A/Prof Anna Ranta: Chair, National Stroke Network

 

REDCap Thrombolysis Register

As of 1 January 2018 all data for the Thrombolysis & Stroke Clot Retrieval Register is entered into the REDCap database.   Thanks to everyone for making the transition so smoothly from the old register and we encourage you to have a go at downloading a report for your site if you haven't done so already.

Please remember to click the 'complete' button when you've finished entering data.

If you have any questions about using the Register please contact Caitlin Taylor - Caitlin.taylor@ccdhb.org.nz

 

South Island Stroke Study Day

Christchurch
1st November 2018
Registrations are now closed for the Study Day as it's FULL; however you can still participate via video link.
Contact Claire Gee:southern@stroke.org.nz

 

Become a member of the Stroke Society of Australasia - NZ Committee

Are you interested in contributing as a committee member on the 'new' New Zealand division of the Stroke Society of Australasia?  This could be your opportunity to get involved at the national level.  The committee members will provide overall SSA-NZ governance, contribute to the organisation of New Zealand and Australasian stroke education events and resources, contribute to regular newsletters, and help to support stroke professional collaboration in the research and education spaces. 

Please see call for Expressions of interest (EOI) for more detail and if interested forward a brief paragraph about yourself and why you are interested in the role to   Executive Secretary Bronwen Pepperell: bronwen.pepperell@tdhb.org.nz. No forms required! EOIs should be received by 31 January 2019.  

 

Regional News - Northern

The Northern Region has launched (3rd September) the second phase of the Hyperacute 
Stroke and Percutaneous Stroke Intervention (PSI) or Clot Retrieval pathway.  This follows on from the successful trial of the thrombolysis pathway with West Auckland patients and the launch of the 24/7 PSI service.
In collaboration with St John using their Pre-hospital Acute Triage in Auckland (PASTA) screening tool to help with decision making, all eligible metro-Auckland stroke patients presenting after hours will now bypass to Auckland City Hospital for hyperacute stroke treatment.
The Northern Region Stroke Network Executive meet on the 12th November, chaired by Dr Alan Davis.  The network has a new Project Manager; her name is Kar Po Chong and she is based at the Northern Regional Alliance. She can be reached at: KarPo.Chong@nra.health.nz

 

Regional News - Midland Stroke Network

The Midland region has a new chairperson, Dr Mohana Maddula from Bay of Plenty DHB. Dr Peter Wright, the network’s previous chairperson, contributed significantly through his leadership and advice over the last few years.

The Midland region Allied Health Stroke Group meets quarterly and continues to gather momentum and numbers. Two Allied Health representatives sit on the Midland Stroke Network and are helping raise the profile of stroke rehabilitation.

 

Northern Region Rehabilitation Research Initiative

An informal meeting of around 30 therapists, nurses, dietitians, psychologists and physicians interested in being part of a regional stroke rehabilitation research group met during the Auckland Stroke Study Day on the 3rd October.  There is genuine and enthusiastic interest in building a network that connects health professionals to raise awareness and participation in multi-site rehabilitation trials in the Northern Region. 

A page has been created on the National Stroke Network website to host information about New Zealand research studies, and you’ll be able to find out who's involved and who to contact for further details. This is still under development but if you'd like more information contact: Cathy Stinear - c.stinear@auckland.ac.nz or Anna McRae - AnnaMc@adhb.govt.nz

 

REGIONS Care update

The HRC funded REGIONS Care project is looking at all patients admitted to NZ Hospitals over a 3-6 month period aiming to capture about 2-3000 patients to help us better understand challenges around access and outcome especially when it comes to ethnic and geographic inequities.  Recruitment is going well and we are now up to 2204 patients in the audit database and 729 consented for extended follow up (target 1028). We are conducting our first focus group later this month in Counties Manukau and have just finished our surveys that will be sent to patients, carers, and some health professionals to explore access barriers.  This project would not be possible without all of your contribution and wonderful collaboration. If you have any questions about the project please contact our study co-ordinator Stephanie Thompson at Stephanie.thompson@ccdhb.org.nz.

 

2018 - 19 indicators for stroke

The Ministry of Health indicators for stroke for the 2018-19 year are:

  • 10% or more of potentially eligible patients are thrombolysed 24/7.
  • 80% of patients admitted with acute stroke are admitted to a Stroke Unit or Organised Stroke Service with a demonstrated stroke pathway.
  • 80% of patients with acute stroke who are transferred to inpatient rehabilitation services are transferred in seven days of acute admission.
  • 60% of patients transferred for Community Rehabilitation are seen face-to-face by a member of the Community Rehabilitation team within seven calendar days of hospital discharge.

The Community indicator is a new measure included this year and in to provide some assistance for stroke teams and DHBs the NSN have developed some FAQs to help.

 

2019 Quality Meeting - Dates for your diary.

The next Acute and Rehabilitation Stroke Quality Days will be held in Wellington on the 6th & 7th of June 2019.

 
 
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