RESUMEN
The New Zealand National Stroke Network introduced a National Stroke Thrombolysis Register on the first of January 2015 to assist with quality assurance and continuous service improvement. In the first 6 months, there were 179 [75 women, mean (SD) age 69.9 (14) years] treated with stroke thrombolysis out of a total of 2,796 ischaemic stroke patients, giving a national thrombolysis rate of 6.4%. The median [Inter-quartile range (IQR)] onset-to-treatment time was 154 (125-190) minutes, and the median (IQR) door-to-needle time was 74.5 (55.7-105.0) minutes. The rate of symptomatic intracranial haemorrhage following thrombolysis was 4.4%. These results are similar to other international centres, and indicate an approximate doubling of the proportion of stroke patients treated with stroke thrombolysis since a 2009 national audit. However, there is need for on-going efforts to improve treatment rates and process efficiency, particularly door-toneedle times.
Asunto(s)
Fibrinolíticos/administración & dosificación , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica/estadística & datos numéricos , Tiempo de Tratamiento/estadística & datos numéricos , Activador de Tejido Plasminógeno/administración & dosificación , Anciano , Anciano de 80 o más Años , Hemorragia Cerebral/epidemiología , Femenino , Hospitales/estadística & datos numéricos , Humanos , Masculino , Nueva Zelanda/epidemiología , Estudios Prospectivos , Sistema de RegistrosRESUMEN
BACKGROUND: In recent years, there has been increased focus on improving the quality of the working lives of staff in health care organizations. Research shows that improvements can be achieved through a comprehensive organizational approach to workplace health. Improved worker engagement is a realizable outcome of such an approach, provided that it is based on reliable and relevant data and is tailored to the specific environment in which it is being implemented. ASSESSMENT OF PROBLEM: An intervention project was designed to develop an organization-wide approach to employee workplace health. A comprehensive health risk assessment was undertaken, along with a staff survey on workplace culture, individual health practice and environmental effects on physical health. RESULTS: In general, the findings present a positive picture of the culture and factors that influence psychological wellbeing. However, improvement is needed in some areas: satisfaction is only marginally outweighing stress, and musculoskeletal disorders account for much absenteeism. Employee health needs include weight management, improving fitness and nutrition, and decreasing coronary risk. STRATEGIES FOR CHANGE: Results have prompted this organization to pursue the development of a Healthy Workplace Policy that will be used as a filter for all other policies relating to workplace culture, environment and practice, and have provided the impetus and focus to review the organization of employee health services. LESSONS LEARNED: Three major administrative activities are necessary to move from planning to sustained action: ensure adherence of all staff to any policy derived from a health risk assessment; ensure staff feel proposed changes are relevant and important; and create a road map to guide the development of a strategic and an implementation plan. The findings outlined in this report can be addressed by organizations that are willing to commit to a comprehensive approach to workplace health.