Stroke service redesign

Stroke service redesignWhat is a stroke?

A stroke is a brain attack and happens when a blockage such as a clot blocks the blood flow to the brain, or when a burst blood vessel bleeds into the brain. Stroke can affect a person’s ability to walk, talk, eat, see, read, and socialise.

Stroke is the third largest killer in New Zealand after heart disease and cancer. Each year around 9,000 people have a stroke and over 2,500 die from stroke. It is estimated that there are 60,000 people living with stroke in New Zealand. [NZ Stroke Foundation]

How can you tell if someone is having a stroke?

the symptoms of stroke you could save a life! Learn the FAST check to recornise symptoms of stroke:

FAST check for stroke symptoms


What are we trying to achieve?

By reviewing how our in-hospital services are currently delivered, and taking advantage of new opportunities, we aim to ensure that all patients who present to our hospitals with stroke always receive the best care possible.

New opportunities include:

  • recent advances in the early treatment of stroke shows that suitable patients who undergo a special treatment to remove the clot which causes stroke have better outcomes. Auckland DHB provides this service for the Auckland region and we want to ensure that our patients have rapid access to this service if needed
  • alignment with a review of hyperacute stroke services underway for the Auckland region
  • the current planning for new buildings as part of the Waitemata 2025 programme giving us the ability to design new wards and facilities for acute and rehabilitation stroke services

What did we find?

To support our service review and to identify areas of improvement we have undertaken:

  1. a stroke services planning day to explore acute care options
  2. a survey with a small number of patients to find out about their preferred location of care
  3. an ‘In Your Shoes’ patient listening forum to learn about patients and families experience of using our stroke service
  4. two ‘In Our Shoes’ staff listening forums to learn about staff experiences caring for patients who have had a stroke

Feedback received informed us that:

  • patients are willing to travel for initial specialist stroke care
  • patients and their families valued the multi-disciplinary team and how they worked with them
  • reducing long waits and delays would improve patient experience
  • providing more information would be valuable to patients and their families
  • staff would like to spend more time with their patients

Our patients told us that the following makes a really positive difference within the stroke service:

What makes a positive difference to patients in the stroke service

What have we done?

We have formed a stroke redesign group consisting of representatives from the inpatient stroke team including specialist stroke and rehabilitation doctors, stroke nurse specialists, managers, nurses and physiotherapists. The stroke redesign group is working on a number of initiatives to improve stroke services including:

  • development of a Hyperacute Stroke pathway to guide staff and improve the patient journey. For conditions like stroke, where early treatment is critical, pathways can make treatment faster.
  • development of a new model of care, which outlines the way the service delivers care to our population, and working with our design teams to plan new purpose built wards and services
  • participation and collaboration in the regional DHB stroke network

Did we make a difference?

The new Hyperacute Stroke pathway was implemented in November 2015 and to date we have seen the following improvements:

1. Patients receiving thrombolysis (clot busting medicine):
Thrombolysis or clot busting medicine can reduce the effects of stroke, and can be given patients with some types of stroke if they present to hospital early.

We have doubled thrombolysis rates since the introduction of the new pathway with the number of patients eligible and who have received this treatment increasing to 6% in first quarter of 2016 (up from 3% in first quarter of 2015). [Regional target is 8%]

2. Patients admitted to a specialised stroke unit:
Admission to a specialised stroke unit (such as Ward 2 at North Shore Hospital or Wainamu Ward at Waitakere Hospital) can improve recovery from stroke.

There has been a 7% increase in patients receiving care in a stroke unit since the introduction the new pathway (86% in the first quarter of 2016 up from 79% in first quarter 2015). [Regional target is 80%]

Where to from here?

  • Development of a new pathway for Transient Ischaemic Attack (warning or mini stroke)
  • Completing the model of care and plan for staged implementation of changes from 2016
  • Completing the design for new wards in 2016