Exceeding Expectations

 
With a population of just over 330,000, not many would have predicted that Iceland was going to qualify for a spot in World Cup 2018. But not only did they become the smallest nation to have participated in the elite competition, they also did it by topping their qualification group, defeating football powerhouses like England and the Netherlands along the way. This is all the more impressive when we consider that its football team was ranked 131 in 2010, the national coach still works as a part-time dentist, and heavy snowfall makes outdoor training impossible for almost half the year.

There have been many speculations about what the determining factor for their success might have been, but most commentators agreed that there were two key attributes: team spirit and determination. It is these two same components, we believe, which have driven the remarkable progress made by the Angels community in Iceland. 

Being the most sparsely populated country in Europe, nearly all stroke patients in the acute phase are treated by Landspitali University Hospital (LUH) in Reykjavik – also known as the National University Hospital – where around 70 percent of Icelandic children are born. 



In December 2017, three nurses from LUH's Neurology Department joined Angels Initiative’s inaugural Train-the-Trainer (TTT) meeting in Wiesbaden: Marianne Klinke, Kristín Ásgeirsdóttir and Jónína Haflíðadóttir. The stakes were high. Unlike other countries where we have at least one dedicated Angels Consultant, it was up to these three determined ladies to take as much learning as they can, and bring them home to implement while juggling their main day-to-day responsibilities. As with the Icelandic football team, nothing could have prepared us for all the surprises achieved by this incredible team. 

In May 2018, less than five months after attending the TTT meeting, LUH reported that they had started implementing a new pathway for administration of recanalization therapy based on insights obtained from several simulations. The results speak for themselves: 296% increase in patients who have received recanalization procedures (compared to 2014 – 2016) and reduction of median Door-To-Treatment (DTT) times from 79 to 25 minutes (record time: 13 minutes) when the pathway is functioning. This was well beyond the goals they had set for themselves which was to diminish DTT times by 50% within the first 6 months and double the number of patients who receive acute recanalization therapy. 

We also admire how quick it took for the nurses to translate and initiate the implementation of the post-acute phase Fever, Sugar, and Swallowing (FeSS) Clinical Treatment Protocols in the stroke unit. By now, the protocols have been taught both within the hospital and within the Icelandic patients’ stroke association and necessary revisions been conducted to ensure better compliance with the guidelines. They have also collected valid baseline data from approximately 200 patients to compare before and after measures. 

To top it all off, in case you thought they were content with these astonishing accomplishments, here are some of the activities planned for the next twelve months:
  • Obtain ethical permission from the Icelandic government to allow data export into RESQ
  • Travel to rural Neskaupstaður and Akureyri to implement pathways and to assist with the first simulations
  • Produce educational videos to ensure continuity of training 
  • Establish pathways for children with stroke and patients that are admitted to other non-specialized wards 
  • Acquire permission for more nighttime staffing to allow for an active care pathway 24/7
  • Collaboration with the Icelandic patients’ stroke association – a stroke day will be held in October 2018
  • Increase patient awareness through mass media involvement 
  • Modify academic curriculum for 3rd year nursing students to include focused stroke teaching and training of cases in managing fever, sugar and dysphagia
  • Establish a national professional stroke society
  • Launch the Icelandic Stroke Registry
The only thing which did not surprise us was how their project received the “Best Project of the Year” award within LUH.

Considering how they tripled their previous goals within less than the set time frame, and supported by growth of the Angels community, we are optimistic that Iceland will continue exceed everyone’s expectations. 

Country: 
Iceland