In an exclusive interview, Dr Joe Harbison, the recently appointed joint national Clinical Lead in Stroke Medicine spoke to Michelle McDonagh about stroke services in Ireland.
Dr Joe Harbison, Consultant Stroke Physician at St James's Hospital, Dublin, and Secretary of the Irish Heart Foundation's Council on Stroke, is to be appointed joint national Clinical Lead in Stroke Medicine, the Medical Independent can reveal.
Dr Peter Kelly, Consultant Neurologist at the Mater Hospital, has been tipped to join Dr Harbison in developing a comprehensive national stroke prevention and treatment service.
Stroke unit care is the most important factor in terms of ensuring the best possible outcome for the patient and every hospital admitting stroke patients should be admitting them to a stroke unit, Dr Harbison told the Medical Independent.
"In 2010, it's as unacceptable not to admit an acute stroke patient to a stroke unit, as it is not to move a heart attack patient to a coronary care unit. Where patients are admitted to a stroke unit and managed properly there, one extra life is saved for every 14 people treated. That's one extra patient who is saved from dying or being left with severe disability."
Dr Harbison said there is a need to improve structures within Irish hospitals for the management of stroke and to put in place strong pathways and protocols - this is already being done in many hospitals, he points out, but needs to be extended to all.
He stated: "Before we do anything though, we must look at stroke prevention. People need to know that they should ring 999 when they first get an attack, not sit and wait for it to go away, as many do. We need to get people educated and aware that stroke is a common disease, but it is treatable if caught quickly."
Three years ago, almost nobody in Ireland was thrombolysing stroke patients, according to Dr Harbison, but today most hospitals provide some form of thrombolysis, albeit often only on a nine-to-five basis. He pointed to a strong willingness in the hospitals to improve and develop this service, although the current economic climate is proving a deterrent. While thrombolysis has been a huge advance in the treatment of stroke patients, Dr Harbison pointed out that it is totally dependent on the patient getting to hospital on time.
"In St James's, we thrombolyse every patient who gets in within four hours but that's still only 3-5 per cent of cases being thrombolysed. The problem is the lack of awareness among the general public about what to do. There's no doubt that thrombolysis has been great for stroke, but it's not the only thing that can be done. If a stoke patient gets to hospital within two hours, their outcome will be better even if they don't receive thrombolysis."
Staff training in stroke management is a major problem at the moment, said Dr Harbison, due to the lack of additional funding in the area. He pointed out that 10,000 people in Ireland suffer a stroke every year and although there are increasing numbers of stroketrained doctors around, they have insufficient time to dedicate to both caring for stroke patients and training staff.
He commented: "Stroke must be given appropriate emphasis within hospitals. It's a disease that is exquisitely sensitive to treatment if caught quickly. There's little doubt that geriatricians and neurologists bring a complementary expertise and skill to the management of stroke patients but we need more neurologists.
"We have the lowest rate of neurologists per head of population in Europe, which impacts on a lot of conditions, including stroke. Over the next few years, we probably need a trebling of neurologists in this country so that all neurological diseases can be managed effectively."
From the rehabilitation point of view, Dr Harbison highlighted the critical shortage of specialist therapists. He pointed out that there are only two or three neuropsychologists in the country trained to treat stroke patients, despite the fact that 60-70 per cent of stroke patients suffer depression and neuropsychological issues after an attack.
"There is also a real shortage of rehabilitation physicians. The National Rehabilitation Centre in Dun Laoghaire does an incredible job, but it's just too small to cater for stroke patients as well as all the country's spinal and head injury cases. They themselves don't think they are taking all the stroke patients they should be or getting them as fast as they should so they have started setting up subunits in Cork and Beaumont. We need more of these kinds of facilities.
"The mistake would be to rush in and make immediate changes when we don't understand the full problem, so consultation and discussion will be a vital first step."
Since Dr Harbison came back to St James's Hospital in May 2006, there have been significant improvements in the treatment and management of acute stroke patients. Bed occupancy has been reduced by 40 per cent, mortality has been reduced by more than a third and length of stay has decreased - all achieved by a tiny team with few new resources.
Next week, St James's will launch its Stroke 2010 fundraising campaign with a springtime-themed event.
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