Best practice for stroke rehabilitation not being met in Wellington

It is even worse than that. Measuring rehab hours is worthless. You measure recovery results, nothing less. You need to replace the stroke leadership with someone who will pursue 100% recovery for all. Leaders tackle the tough problems. Do you want leaders or not? If you do, you need to fire a lot of people. 

Best practice for stroke rehabilitation not being met in Wellington

Stroke patients in Wellington are falling "well short" when it comes to meeting recommended rehabilitation hours and face longer-than-advised wait times for appointments.

Published on Friday in the New Zealand Medical Journal, a newly released audit report co-authored by Stephanie Thompson from Capital & Coast DHB, found new stroke patients received, on average, just over 30 minutes of rehabilitation per week.

Additionally, they waited 10 days after being discharged for a rehabilitation appointment.

The results are at odds with the New Zealand Stroke Network recommendations that patients should be seen within seven days of discharge, and receive a minimum of three hours of therapy per speciality per week.

Canines helping out with stroke therapy

Hutt DHB occupational therapist Kerry McKiernan and her dog Ollie after extensive training are taking stroke therapy to new levels.

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Rehabilitation involved physiotherapy, speech therapy and occupational therapy sessions, among other things, with the global consensus that the sooner sessions began, the more likely someone was to regain lost abilities and skills.

Fifty patients with a new diagnosis of stroke were included in the 2016/17 audit, with all of them having been referred to the Wellington Community Older Adults, Rehabilitation and Allied Health (WCORA) team.

The report found that patients received an average of 4.3 visits from all required disciplines combined during the first four weeks after hospital discharge.

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Most strokes are caused by an abrupt blockage of arteries leading to the brain but can also be caused by bleeding into brain tissue when a blood vessel bursts.

The average amount of rehabilitation time increased slightly to 43 minutes per week when the researchers looked more widely at the first three months following a stroke patients discharge.

Thompson and her team found was there were delays in providing an initial community rehabilitation appointment.

Julie Furfie from Stroke Central – an organisation which supports the region's stroke survivors in their recovery – said they received an average of 80-90 referrals a month with the majority of people requiring rehabilitation.

She said as much as "the girls" tried to point people in the right direction, sometimes it could be a struggle to find the right rehabilitation in a timely manner.

"There aren't enough physios, speech therapists ... We just don't have the manpower to give people what the need."

The support available in Wellington has been described by patients and their families as "fragmented and difficult to arrange".

"At the end of the day, the research for help and assistance eventually ends up the responsibility of the stroke survivor or their carer, leading to many hours on the computer, or at the local library, or on the phone," a parent of a stroke survivor said.

Thirty-seven per cent of patients surveyed for the audit met best practice guideline in being seen within seven days of hospital discharge but some waited up to a month to be seen for their first appointment.

That percentage falling well short of the Ministry of Health's indicator of 60 per cent.

While the results showed best practice wasn't being met in the region, it had pushed researchers to put forward recommendations for service improveme

nts to be made

"Service redesign may be needed to improve community stroke rehabilitation provision against the Ministry of Health indicators, and further work is required at a team level to implement suggested changes," the report said.