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Deliverables for 2012
QUALITY
Develop governance structure
· National project team and working group established
· Local stroke teams – full team in 52% hospitals; partial in 45% hospital (Nov. ’11)
· Hospital/Networks submitted Area Implementation Plans
Develop and disseminate care pathways (CP), protocols andcare bundle (CB)
· CB for acute stroke, TIA, carotid stenosis management available here
· CB Stroke unit, CP thrombolysis, post stroke - brain imaging, depression, heart rate and pyrexia monitoring, pain, urinary incontinence, hypertension in draft
Increase anticoagulation in known atrial fibrillation
· Chronic Disease Watch submission made
· AFib care pathway in final draft
· Survey of hospital warfarin services – report in final draft
· Plan to implement AFib screening programme in two sites 2012
Develop a stroke register
· National Stroke Register Interim Implementation Group established in partnership with ESRI
· Stroke Portal developed and piloted in 6 hospitals in 2001
· Data set refined
· Roll out in progress with target of 80% by Q3 2012
Audit planned for 2012 (Philip Crowley’s office)
ACCESS
Develop national 24/7 access to safe stroke thrombolysis through service development, telemedicine and training
· 24/7 thrombolysis available in many hospitals with access protocols agreed for others
· Ambulance access protocols - working in partnership with national ambulance service to agree and implement ambulance access protocols
· RCPI tPA training programme in place-need for regional ownership
· Telemedicine Rapid Access for Stroke and Neurological Assessment (TRASNA) programme will be implemented in 2012
Develop national access to Stroke Unit care in all hospitals accepting stroke patients
· % discharges from hospitals with stroke units
· 2010 58.5% (HIPE 2009 discharges)
· 2011 81% (HIPE 2010 discharges)
· Anticipated position at end of Q4 2012 97.4% (HIPE 2010 discharges)
Develop national access to rapid TIA assessment
· Care Bundle developed and disseminated
· Plan for implementation in 2012 including improved access to diagnostics
Develop early supported discharge programme
· Two pilot programmes developed and implemented in NE (Mater hospital) and DML (Mullingar hospital)
· Plan for 2 more sites in 2012 DML (James’s/AMNCH) and West (Galway)
COST
Achieve cost savings through reduced AvLOS for stroke patients through improved access to stroke unit care
· Cost of Stroke Care in Ireland Study estimated that approximately €5 million could be saved annually through the provision of stroke unit care to 95% of admitted patients
· Target 50% by end 2012
· Target reduction of 2 days in AvLOS
· Reduction in rate of discharge to nursing homes by 1.5%
Achieve cost savings through reduced AvLOS for TIA patients through improved access to rapid assessment
· Target to reduce AvLOS by 3 days
· Prevent stroke in at least 140 patients annually
Achieve cost savings through reduced LOS by implementing early supported discharge for selected stroke patients
· Early evaluation results from 2011 pilot sites show promising results in terms of cost savings
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