GPs and other health professionals will focus on improving the quality of care for stroke patients at the annual stroke study day in November. The event is being held in Christchurch and delivered jointly by the Stroke Foundation of New Zealand and the South Island Alliance’s stroke services team. Register for the event here…

Stroke survivor Darryn Williamson shared his story with health professionals from across the South Island at the annual Stroke Study Day in October.

Almost 170 stroke service providers, including general practitioners and practice nurses, listened as Darryn spoke about his experience through the health system and his journey to recovery.

Emphasising the importance of communication and truly listening to the patient, Darryn was a very active person before his stroke in May 2018. He was on 13 boards, including the Canterbury DHB Consumer Council. “It’s very frustrating not being able to do what you used to do – when you have a stroke, you lose a lot more than your dignity.”

Darryn’s journey has taken over a year to get back to independent living. He talked about his experience and took questions from the audience, encouraging understanding and learning from a patient’s perspective. He says clear communication with the patient and between health professionals is crucial. “It’s about finding out who your patient is first, by talking to them, not just reading what’s been written about them from a folder. Really listening to the patient is so important – setting rehab goals and involving them with everything – asking them, what do they need to get over this hurdle or reach this next step towards their recovery?”

The strong speaker line-up also included two researchers, one of which was Nicola Kayes, Director of Person Centred Research Associate Professor of Rehabilitation School of Clinical Sciences, Auckland University, whose research is about goal setting.

In her presentation, Nicola explained that SMART goals have minimal evidence supporting their use in rehabilitation. She presented an alternative goal-setting framework (MAP: Meaning, Anchor, Plan), making rehabilitation plans tailored to the person. It reinforced Darryn’s message of listening to the patient and asking what they want. This framework fits with any chronic condition/rehabilitation type goal.

Jointly hosted by the Stroke Foundation of New Zealand and the South Island Alliance Stroke Workstream, 170 people attended, with more than 100 joining by video conference. Held at the Rolleston Lecture Theatre at Christchurch Hospital, the event is focused on helping service providers enhance their day-to-day practice.

This year, the range of stroke-specific topics included dysphagia management, sexuality after stroke, and the implementation of telestroke in the South Island.Attendees also had a chance to ask questions about anything to do with stroke care, answered by Dr Suzanne Busch, Lead Stroke Physician, Nelson Marlborough DHB, and Dr Carl Hanger, geriatrician and stroke physician at Burwood Hospital.

Dr Hanger was one of the event organisers and says the day was a great success. “Our speakers were fantastic, and we really appreciated Darryn for his courage and honesty in sharing his experience both in and out of hospital following his stroke. It’s really beneficial for us as health professionals to hear a consumer’s perspective first-hand.”

The South Island’s new telestroke service has been launched between the West Coast and Christchurch, giving more people faster access to potentially life-saving acute stroke treatment.

Using dedicated video-conferencing and CT image technology, the telestroke service enables neurologists and stroke specialists to provide advice and support via video link to doctors treating stroke patients in smaller centres and after hours.

Dr Teddy Wu, one of six neurologists at Christchurch Hospital, says the service has transformed stroke care. “This is real-time care – it’s like watching a movie and giving instructions. While we can’t touch the patient, we can ask the doctor to examine them on our behalf. Potentially, one of the key aspects is deciding whether we need to fly them to Christchurch Hospital for a clot removal procedure. What this means is, more people who experience paralysis from a major stroke will be able to walk out of hospital within a few days.”

Following the successful 2016 telestroke pilot between Wellington and four smaller centres, including Nelson and Wairau in the South Island, the Ministry of Health provided funding for the equipment and implementation costs for a similar service across the South Island. Through the South Island Alliance, the five South Island DHBs developed a hub-and-spoke model, comprising six ‘spoke’ hospitals (Grey Base, Timaru, Oamaru, Dunedin, Dunstan and Southland) supported by a ‘hub’ hospital (Christchurch). If a person presents to a ‘spoke’ hospital emergency department (ED) with a suspected stroke, the local ED team can notify an on-call neurologist or stroke specialist at Christchurch Hospital, who can then read the patient’s CT scan, provide advice and make a diagnosis.

The South Island telestroke service will help to ensure smaller communities can access the same 24/7 neurological expertise and care as city patients. Ideally, it will also lead to more South Islanders receiving the life-saving clot retrieval procedure, which is currently available only at Christchurch Hospital.Dr Wu anticipates the remainder of the South Island telestroke service will be linked up by the end of the year.

Visiting stroke survivors in their own homes helped acute stroke unit nurse Debbie Allen to look at the person as a whole. “It’s about really seeing the person, not necessarily the patient,” she says. “When people are in hospital, a patient is who we see them as, but when they go home of course they’re part of something much bigger that we don’t get to see.”

Debbie presented at the annual South Island Stroke Study Day earlier this month about the impact of visiting people at home who had experienced a stroke, as part of a research project. “The research was about listening to what they want and to see if we could help them reach that goal. I ended up gaining more of an understanding about the problems they had that we don’t see when they’re in hospital.”

Debbie has been attending the study days for the past few years and this was the first time she had made a presentation. This year’s event was held on 1 November 2018, with 185 health professionals attending in person – from stroke service providers and stroke teams, to general practitioners and practice nurses. An additional 100 plus attendees linked into the event via video conference, across 11 sites across the South Island. One of eight presenters on the day, Debbie spoke about what she realised while visiting the stroke survivors at home. “When you go into somebody’s house, you see trophies, photos, paintings and gardens – you see much more of who they are. And because the visits weren’t time restricted, there was time to chat one-on-one with them about their situation and challenges – whereas in hospital you don’t have the time to do that.”A registered nurse for 35 years, Debbie has worked in the Christchurch Hospital Acute Stroke Unit since it opened 12 years ago. She says stroke care has progressed a lot over the years. “We’ve got a really good system, it caters to people throughout every stage, from diagnosis to rehab.”

As a student in training many years ago, one patient in particular still sticks in her mind. “She was a lovely lady who had a very dense stroke, so she couldn’t speak. She was in the ward for months and received very good care, but no rehab or anything, so her potential was never realised. Now I can see what she could have received when I look at the assistance our patients currently get – we have come so far since then. I think about her a lot.” Years ago, strokes were often viewed as the ‘end of your life’ and were more accepted as being just a part of getting older, Debbie says. “Now, there is more emphasis on prevention because we are doing a much better  with messages  – such as increased awareness by the Stroke Foundation, which is doing a great job, earlier diagnosis, as well as better

Another hospital patient Debbie spoke about during her presentation was a woman who she was unsure about discharging. “She seemed quite lost and being in hospital seemed very difficult for her. We wondered how she would cope at home as she had a husband who had also experienced a stroke, a few years back. After delaying her discharge, we eventually sent her home and I called her and asked if she wanted to be a part of the research project.

“However, when I visited her a few days later, I couldn’t enrol her in the project because she was doing so well. Once she was back in her own environment, she was no longer worrying about her husband and they were looking after each other. She was back to doing everything she did before her stroke. So, it was interesting that when she was out of her context, she came across as confused and lost, but in her own home she was fine and there was nothing she couldn’t do.”

The research project was part of a study through the Medical Research Institute of New Zealand, which recruited 400 patients nationwide. Debbie says being involved in the research gave her a completely different perspective on stroke care. “One of the ladies I talked to had a goal of wanting to go on a cruise. She couldn’t even go outside for a walk as she lived on a hill, but her main aim was to go on a cruise – and that’s exactly what she ended up doing.”

Presented by the South Island Alliance and Southern Stroke Foundation, the annual Stroke Study Day focuses on enhancing the daily practice of stroke delivery and quality care. Other presentations this year included depression after stroke, cognitive changes following a stroke, aphasia, as well as a stroke survivor who spoke of her own stroke experience and journey to recovery. Debbie says it’s interesting to learn about different subjects each study day, as attendee numbers continue to grow every year. “One of the nurses I used to work with in the stroke unit here in Christchurch moved down south to work at Dunstan Hospital. After the study day, I got a message from her saying she had watched my presentation on their VC unit, so I thought that was really cool that they were also getting a day’s education down there and professionals from all over the South Island had the opportunity to watch it.”

Acute stroke unit nurse Debbie Allen delivering her presentation at the 2018 South Island Stroke Study Day.

Stroke Study Day 2017: Four members of the organising committee (L) Clare Jamieson, Jane large, Julian Waller, Dr Carl Hanger and keynote speaker, Dr Lynne Clay.

Almost 250 health professionals working in stroke care across the South Island returned to work with new ideas to enhance their daily practice following the 2017 Stroke Study Day last month. The annual event is focused on improving the quality of care for stroke patients and was attended by service providers, stroke teams, GPs and practice nurses from across the continuum of care – acute care and thrombolysis, through to inpatient and community rehabilitation at home and in residential care.

This year’s case study was a stroke survivor from Christchurch, who took the stage to share his incredible journey to recovery. Eddie was 34 years old when he suffered a stroke following heart surgery. He talked about his experience both in and out of hospital and took questions from the audience, encouraging understanding and learning from a patient’s perspective.

Canterbury DHB community geriatrician Dr Michaela Glanville attended the event at Rolleston Lecture Theatre on 2 November. She says Eddie’s story was “a heart breaking insight into the difficulties of the more silent aspects of stroke, such as severe visuospatial difficulties, bone-numbing fatigue and feelings of grief and loss, whilst trying to maintain a relationship with his partner and toddler son. It made me reflect that we need to see the person, not just the condition.”

Dr Carl Hanger, geriatrician and stroke physician at Burwood Hospital and clinical senior lecturer in medicine at the University of Otago, Christchurch, is one of the event organisers. “Many of the health professionals attending want additional input teaching to upskill themselves, yet don’t have a lot of opportunity to do so. The study day provides one such opportunity.”

The event was video-linked across sites all over the South Island, making it easier for smaller centres to participate, he says. “We had 148 people attend in person and 96 via video conference in Nelson, Blenheim, Greymouth, Buller, Hokitika, Invercargill, Clyde, Timaru and Dunedin. Approximately a quarter were from acute care settings, quarter from inpatient rehabilitation, quarter from primary/community care and quarter from age residential care – we had the mix about right, covering the whole spectrum. It’s great to see such a large group getting excited about stroke care – it bodes well for the future.”

One of the speakers, Dr Suzanne Busch, presented on imaging, diagnosis and demystifying the medical language of stroke.

A range of experts also presented at the event, including Dr Suzanne Busch, physician at Nelson Marlborough DHB, who spoke about imaging, diagnosis and demystifying the medical language of stroke.  “I was asked to talk about the medical technology of stroke but came to realise that the language we use is often responsible for patients and professionals not fully understanding either the cause or deficits of strokes – it’s much better for our patients and colleagues when we use plain English as much as possible,” she says.

Other speakers included Pauline Owens, a stroke nurse specialist from Counties Manakau DHB, who discussed how stroke care has changed over the years, current challenges and strategies to overcome them including building stroke nurse expertise. Burwood Hospital neuro rehabilitation practitioner Dr John Maasch presented on disorders of object and spatial perception and Dr Teddy Wu, a neurologist at Christchurch Hospital, discussed endovascular clot retrieval.

The event’s keynote address was presented by Dr Lynne Clay, lecturer and graduate research coordinator of the School of Physiotherapy, University of Otago, who spoke about the different stages of spasticity.

Canterbury DHB social worker Beth Munro attended the event and says she particularly enjoyed the presentation by Hector Matthews, Executive Director of Māori and Pacific Health, Canterbury DHB, on Māori perspectives on stroke. “Hector was a very engaging speaker. I was surprised by the high stroke number within the Māori population and that most strokes occur under the age of 65. The quote, ‘Equality is giving everyone a shoe, equity is giving everyone a shoe that fits’ has definitely encouraged me to be more mindful of how our systems and policies align with Māori perspectives and Whānau Ora.”

The annual event was held at the Rolleston Lecture Theatre at Christchurch Hospital on Thursday 2 November and delivered jointly by the Stroke Foundation of New Zealand and the South Island Alliance’s stroke services workstream. Plans are underway for next year’s event, which will be held 1 November 2018.

GPs and other health professionals will focus on improving the quality of care for stroke patients at the annual stroke study day in November. The event is being held in Christchurch and delivered jointly by the Stroke Foundation of New Zealand and the South Island Alliance’s stroke services team. Register for the event here…