Oral Presentation Smart Strokes Annual Scientific Meeting 2024

NSW Rural Stroke Network: patient care first! (106633)

Donna Jay 1 , Jaclyn Birnie 2 , Kelly Andersen 3 , Amanda Buzio 4 , Kristine Joyce Caprecho 5 , Cecelia Duley 6 , Melissa Heazlewood 7 , Kim Hoffman 6 , Emma McCartney 8 , Katherine Mohr 7 , Rachel Peake 9 , Fiona Ryan 10 , Lauren Saunders 11 , Debra Sloane 12 , Jenni Steel 13 , Andrea Thatcher 4 , Emma Turner 5 , Danielle Wheelwright 11 , Natalie Wilson 11 , Melissa Winkelmelon 1 , Johanne Wykes 9
  1. Illawarra Shoalhaven LHD, SHOALHAVEN, NSW, Australia
  2. Hunter New England LHD, ARMIDALE, NSW, Australia
  3. Northern LHD, Tweed Byron Health Services Group, NSW, Australia
  4. Mid North Coast LHD, COFFS HARBOUR, NSW, Australia
  5. Southern LHD, MORUYA & SOUTH EAST REGIONAL , NSW, Australia
  6. Northern LHD, LISMORE, NSW, Australia
  7. Murrumbidgee LHD, WAGGA WAGGA, NSW, Australia
  8. Hunter New England LHD, MANNING, NSW, Australia
  9. Hunter New England LHD, TAMWORTH, NSW, Australia
  10. Western LHD, BATHURST AND ORANGE, NSW, Australia
  11. Agency of Clinical Innovation, SYDNEY, NSW, Australia
  12. Western LHD, DUBBO, NSW, Australia
  13. Mid North Coast LHD, PORT MACQUARIE, NSW, Australia

Introduction: Since 2009, stroke care coordinators of the NSW Rural Stroke Network (RSN) have implemented innovative ways of monitoring stroke care. In 2020 the RSN together with Agency of Clinical Innovation (ACI) Stroke Network developed NSW Realising Improvement in Stroke (RISE) to collect standardised data, review trends, benchmark and encourage quality improvement. We describe characteristics of stroke presentations from 2021-2023 and compare door-to-needle time and stroke unit access to state and national benchmarks.

Methods: Demographic and clinical stroke care data were entered into RISE by 18 RSN sites. Descriptive statistics are presented for demographic data and trends over time for clinical care data for patients with a diagnosis of stroke and TIA.

Results: Complete data sets of 7511 patients were included. 43% were female, 5% identified as Aboriginal and/or Torres Strait Islander, median age was 76 years (IQR 66,84), and 23% ≤ age 65. Stroke type were 65% ischaemic, 10% haemorrhagic and 24% TIA, patients took a median time of 374 minutes (IQR 118,1167) to arrive to hospital, 44% of patients presented to hospital within 4.5 hours, and 80% within 24 hours. For ischaemic stroke patients who received thrombolysis (n=470), median door-to-needle times decreased each year (2021:68minutes (IQR 56,88), 2022:63minutes (IQR 52,79), 2023:57minutes (IQR 47,74)). Stroke unit access decreased from 76% in 2021 to 72% in 2023.

Conclusion: RISE provides a comprehensive overview of stroke/TIA presentations and enables individual and collective review of trends and benchmarks, particularly useful during the challenging COVID-19 pandemic where RSN sites demonstrated high compliance with stroke key performance indicators (KPI). Achievements include exceeding the statewide stroke unit access benchmark (40%) and national door to needle target (˂60minutes).

Relevance to clinical practice: RISE allows stroke coordinators to identify trends, monitor care and act on unwarranted clinical variation to maintain high levels of compliance with stroke KPIs.