Reaching Out – Reaching Up!

“Every time I give the bolus my stomach turns, even to this day. Treating a stroke patient with potentially dangerous medication is scary, especially in the beginning. I remember when we started treating patients some years ago other doctors criticized us. You’re not doing it for the patients, you’re doing it for yourself they said. I felt like I was alone on an island with no one around to help or support me on my quest for better outcomes.”
(Polish Strokeologist, Angels Initiative Kick-Off Meeting, Mainz)



The Stroke Unit at Madeira’s Hospital Dr. Nélio Mendonça is on an island off the coast of Portugal, so just like the colleague quoted, we have all the reason to feel a little disconnected from other stroke centres and specialists.

Our Stroke Unit was officially opened in July 2009, with 4 beds dedicated to acute stroke. The distance between Madeira and Continental Portugal obliged our Stroke Centre to include endovascular intervention, which we are now proud to be able to offer since March this year. This was a great achievement for all the team and we believe will have a high impact on the stroke patients and their families.

We decided to join the Angels Initiative in November 2016 because we saw the opportunity to become part of something bigger. We were reaching for higher performance and desperately wanted to improve our outcomes, but felt we should also reach out. We could do with a bit more knowledge about what others in Portugal and in the rest of Europe are doing to improve their outcomes.

For some, being part of a community might mean physically being together on a weekly or monthly basis to share ideas or build relationships, for us the Angels community took a slightly different form.

It started with our nurses who were exposed to on-line stroke nurse e-learning modules. It was great as it has allowed us to standardize the level of knowledge within the nursing team.

The Body Interact clinical case simulations provided the stroke team with an excellent platform to sharpen our clinical decision making skills which has really helped us also in real life scenarios.

Even though we were not in the same room as our colleagues from the mainland we were already starting to feel that our standards were getting more aligned.

Data collection is the bane of all of our lives but Claudia managed to convince us that the only way to really compare ourselves with hospitals elsewhere would be to start with some data collection. We have now started using the Angels Plus tool and hope that this would allow us to not only track our progress, but also do some benchmarking with our colleagues on the mainland. Nothing motivates like a bit of healthy competition.



If we ask our stroke team which of the elements that Claudia introduced to our stroke unit has helped the most in terms of every day work, it would probably be the introduction of checklists. Of course we had protocols, but if we had to be honest, it was not really something we referred to on a daily basis. This caused a lot of variability in treatment practices. Claudia helped us transform our protocols into easy to use checklists based on the examples they put together with the help of expert advisors. We now use these checklists for every patient we treat knowing that even in this aspect we are on par with guidelines and the best practice in Europe. The nurse has her sheet, the doctor has his and our next priority is to get the ambulance team to also start using one. These days there is very little second guessing and much improved confidence levels from all involved.

The Basecamp community platform allowed us to feel like we are much closer to the other stroke units in Portugal as we could see what others are posting and comment on activities taking place. A great example was the recent Portuguese stroke day where hospitals from all over the country took part in various activities to promote better stroke recognition and treatment.

Due to this suggestion, this was the first year that we celebrated the National Stroke Day in Madeira. We were at two primary health centers, Machico and Ribeira Brava, discussing stroke and the role they could have.

The stroke team in Madeira agrees that the biggest asset when it comes to making us feel part of this larger community has been our consultant Claudia. Yes, we had the materials and tools that the project provided, but we feel that our consultant is our primary link to the rest of Europe. She has a perspective that we did not have access to before because she also works in other hospitals too. She sees what others are doing that works and passes the tips and tricks on to us. She also has access to a much broader knowledge base as she has daily interactions with other consultants that are doing the same thing on other European countries. It’s quite refreshing sometimes to hear your situation is not as dire as it is for others in Romania for example, or to hear an inspirational story from the Ukraine or Italy. We have found that the core of our new community is not just in a workshop or an online forum, it’s also in a person that tells us the stories that inspire us and inspire others by telling them ours.

Enf Arlinda Oliveira, Dr Patrício Freitas and Dr Rafael Freitas
Country: 
Portugal