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22. European Stroke Conference 359 Management and economics Improving stroke services across a population in a financial crisis. The Irish National Stroke Programme P.J. Kelly1, C. Brennan2, B. White3, E. Shelley4, P. Durcan5, A. Carroll6, I. Noone7, U. Cunning-ham8, A. Burke9, B. Smyth10, J. Harbison11 Neurovascular Unit for Translational and Therapeutics Research, Mater University Hospital/ University College Dublin, & HSE National Stroke Programme, Dublin, IRELAND1, HSE National Stroke Programme, Dublin, IRELAND2, HSE National Stroke Programme, Dublin, IRE-LAND3, Department of Public Health, & HSE National Stroke Programme, Dublin, IRELAND4, HSE National Stroke Programme, Dublin, IRELAND5, HSE National Stroke Programme, Dublin, IRELAND6, St. Vincent’s Hospital, & HSE National Stroke Programme, Dublin, IRELAND7, Mater Misericordiae University Hospital, & HSE National Stroke Programme, Dublin, IRELAND8, HSE National Stroke Programme, Dublin, IRELAND9, Department of Public Health HSE West, & HSE National Stroke Programme, Galway, IRELAND10, St. James’ Hospital, & HSE National Stroke Programme, Dublin, IRELAND11 Introduction: The 2006 Irish Stroke Audit showed that stroke services in Ireland were under-developed with only 1% of patients treated with thrombolysis and only one acute Stroke Unit. In 2008 the Irish banking system collapsed, precipitating International Monetary Fund intervention in 2010 and a 22% reduc-tion in the national health budget. In 2010, in this context, a National Stroke Programme was estab-lished to improve the quality, access and cost-effectiveness of stroke services in Ireland. Methods. Key initiatives were prioritised for implementation in 2011-2012: • Stroke units in all 28 larger hospitals accepting acute stroke patients. • Strategic appointment of stroke physicians, nurse specialists and rehabilitation therapists, • A stroke thrombolysis training and delivery programme to provide national equitable 24/7 thrombolysis • Development of standardised stroke/TIA care pathways • Early supported discharge pilot projects in 3 urban areas • A stroke education programme for healthcare staff • A national Stroke Register • Gap analyses and plans for atrial fibrillation and stroke community services Results: 49 new stroke physicians, nurses and therapists were appointed, with 8 new and 19 existing Stroke Units developed (96% of hospitals providing emergency stroke care). National thrombolysis rates increased 3-fold, approaching 10% in 2012. 9 care pathways were developed. By end 2012, the Irish Stroke Register was operational in 83% of acute hospitals. Compared to 2005-09, in-hospital stroke case fatality reduced from 17.5 to 16.1% (p=0.04), acute hospital stroke discharge to nursing homes reduced from 17.6 to 14.8% (p<0.001). Cost savings from reductions in nursing home use by stroke patients were €7.5 million in 2011 (projected €21.5 million by 2013). Conclusion: Initial results from the Irish Stroke Programme suggest improved access, quality of care, and out-comes at a population level, with simultaneous cost savings despite national health budget reduc-tions. 476 © 2013 S. Karger AG, Basel Scientific Programme 360 Management and economics Ireland’s National Stroke Programme: Early Supported Discharge (ESD) –A Pilot Initiative U. Cunningham1, H. Gee2, A. O Connor3, A. Bourke4, C. Brennan5, A. O Carroll6, P.J, Kelly7, J. Harbison8, G. O Neill9, M. O Keefe10, C. Prendergast11, L. Johnson12, E. Reynolds13, G. Casey14, S. Murphy15 Mater Misericordiae University Hospital, Dublin, IRELAND1, Mater Misericordiae University Hospital, Dublin, IRELAND2, HSE Dublin North City, Dublin, IRELAND3, HSE National Stroke Programme, Dublin, IRELAND4, HSE National Stroke Programme, Tullamore, IRELAND5, HSE National Stroke Programme, Dublin, IRELAND6, HSE National Stroke Programme, Dublin, IRE-LAND7, HSE National Stroke Programme, Dublin, IRELAND8, HSE Dublin North City, Dublin, IRELAND9,HSE North City, Dublin, IRELAND10, Mater Misericordiae University Hospital, Dub-lin, IRELAND11, Mater Misericordiae University Hospital, Dublin, IRELAND12, Mater Misericor-diae University Hospital, Dublin, IRELAND13, Mater Misericordiae University Hospital, Dublin, IRELAND14, Mater Misericordiae University Hospital, Dublin, IRELAND15 Background The Irish Health service is undergoing significant transformation with reduction in length of hospital stay and enhancement of primary care services as key objectives. Early supported discharge (ESD) for the stroke population is an internationally accepted model of care. This one year pilot study aimed to test the feasibility and efficacy of ESD in an Irish context. Methods A multidisciplinary ESD team was established at a major teaching hospital with both hospital and local primary care service representation. All stroke patients admitted to the hospital over a one year period were screened for ESD using pre-defined criteria. The ESD outreach team delivered up to 8 weeks intensive rehabilitation to patients in their own homes and outcomes were assessed using Modified Barthel Index, AusTOMS, and 39 SAQOL on hospital discharge and again on completion of ESD rehabilitation. Patient and carer satisfaction with ESD and hospital length of stay were eval-uated. Results Of the 419 registered stroke patients, 12% (n=49) were discharged to their own home via ESD. Mean length of stay for ESD patients was 28 days versus 37 days for the overall stroke population. All ESD patients demonstrated statistically significant improvements on all outcome measures. Ninety per cent or more of the patients and carers expressed satisfaction with each of the measured dimensions. When pay and non-pay costs were accounted for, the overall crude net saving from “441 saved bed days” was in the region of €140,000 and a more detailed health economic analysis is warranted. Barriers to instigation of ESD for patients included limited ESD geographic catchment area, limited ESD team resources and lack of appropriate primary care supports. Conclusion This study demonstrated that ESD is a viable and effective model of care in the Irish context and should be rolled out on a national basis with a target of 25-40% of stroke patients availing of ESD, consistent with the international norms.


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