Stroke care in Australia: why is it still the poor cousin of health care?

To the Editor: We concur with Hoffman and Lindley that dedicated funding for implementation of a comprehensive stroke strategy is overdue.1 The importance of funding the implementation of evidence-based care has been recognised by the New South Wales Agency for Clinical Innovation (ACI). Two key projects are currently putting high-level evidence into practice in NSW. The first is the Quality in Acute Stroke Care (QASC) Implementation Project, a statewide translational quality improvement activity implementing evidence-based clinical protocols to manage fever, hyperglycaemia and swallowing,2 in all 36 NSW stroke services during 2013.3 The second is the NSW Stroke Reperfusion Service,4 which aims to decrease treatment delays using an evidence-based pathway involving paramedic rapid transfer to the closest acute stroke thrombolysis centre.5 This service was introduced in 20 NSW hospitals in 2012. Both projects are translating evidence into practice, and are prime examples showing how the NSW Ministry of Health and its key pillars such as the ACI are enabling clinicians to close evidence–practice gaps. Rigorous evaluations of both these initiatives are being undertaken, examining patient outcomes and clinician practice-change measures, and will be completed in the first half of 2014. These projects are examples of funded, evidence-based activities that show how research can be translated in the real world and on a large scale. Initiatives such as these are critical; they require dedicated funding thereby demonstrating a serious commitment to closing evidence–practice gaps.