New Zealand Clinical Guidelines for Stroke Management 2010
Much has happened since the publication of the last New Zealand stroke guideline in 2003, “Life after stroke‟ (Baskett & McNaughton, 2003) and after seven years, revision of the guideline is considered overdue. However, the two most important recommendations in this guideline have not changed since 2003, and the critical areas of stroke management where a change in practice would make an important difference to outcomes for people with stroke remain.
1. All District Health Boards (DHBs) should provide organised stroke services.
2. All people admitted to hospital with stroke should expect to be managed in a stroke unit by a team of health practitioners with expertise in stroke and rehabilitation.
Implementation of the evidence-based practice described in this guideline is critically dependent on provision of these services by DHBs.
Frameworks for provision of organised stroke services in DHBs of all sizes in New Zealand have been updated since 2003 to explicitly include acute stroke thrombolysis, pathways for management of transient ischaemic attack (TIA) and community stroke teams, and are detailed in the chapter „Stroke service provision in New Zealand‟. The 2003 definition of a „stroke unit‟ has been retained.
A “stroke unit”:
is a geographically-located area where people with stroke are managed
has staff organised into a coordinated interdisciplinary team
has staff who are knowledgeable and enthusiastic about the management of stroke
provides ongoing education about stroke for staff, people with stroke and caregivers
has written protocols for the assessment and management of common problems related to stroke.
Since 2003 there has been a significant increase in availability of organised stroke services and stroke unit care across New Zealand; however, many gaps still remain. A national audit of acute stroke services was performed in 2009 (SFNZ, 2010). Only 39% of stroke patients in New Zealand are admitted to a stroke unit. While more than 80% of the New Zealand population now lives in a DHB which provides an acute stroke thrombolysis service, last year only 3% of patients admitted to hospital with stroke received this treatment (SFNZ, 2010)