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Background Thrombolysis treatment varies considerably between in- and out-of-hours services. Aims This improvement initiative aimed to upskill acute stroke unit nurses as stroke thrombolysis response nurses, testing a new model of nursing in readiness for hyperacute stroke unit developments. Methods Three registered nurses were trained to a specialist competency framework. The role was tested over 28 weeks, and times to treatment milestones were measured. Thrombolysed patients from the test period were statistically compared with a matched group using a two-sample t-test in Excel. Qualitative feedback was sought from the stroke team, medical and emergency department colleagues. Findings Median out-of-hours door-to-needle time reduced from 85 to 61.5 minutes. Statistically significant differences were seen in the time to stroke unit admission (p=0.012) and swallow screen (p=0.038). Stroke and emergency department colleagues considered the role essential to out-of-hours thrombolysis treatment. Conclusions The stroke thrombolysis response nurse role reduced variation in treatment and improved timely acute stroke care. This work may inform the development of stroke nursing workforce models.

The current trend in healthcare is to develop a stronger community service, with the aim of improving and maintaining patients' health, thereby avoiding hospital admission, with potential cost savings. In 2005, the Department of Health overhauled the way the National Health Service manages patients with chronic conditions by recruiting 3000 community matrons to provide care closer to home. The advantages of avoiding hospital admissions are as follows: a reduction in the cost of healthcare, a reduction in the incidence of hospital-associated problems and the provision of care closer to home. This is a service that provides active management of the patient in his or her own home by a healthcare professional, when otherwise hospital admission would have been required. The supporting evidence for intermediate care is weak, and is limited to early discharge of patients from secondary care.

A number of risk factors for chronic obstructive pulmonary disease (COPD) have been identified. The single most important cause of COPD is cigarette smoking, but other risk factors include the effect of diet, early childhood diseases and genetic factors. Individual susceptibility to developing COPD in relation to cigarette smoking varies. Fletcher C. and colleagues showed that although chronic bronchitis and progressive airway obstruction were both related to cigarette smoke, some conditions were distinct with regard to prognosis. Cannabis is often mixed with tobacco, and cannabis smokers often inhale more deeply than cigarette smokers. A dietary deficiency of antioxidants has also been postulated to increase the risk of COPD. Pre-existing bronchial hyper-responsiveness is another risk factor. Although there are many reports of a genetic association with COPD, few of these findings have been replicated in different populations. COPD is common among low socio-economic groups, due to high levels of smoking and poor nutrition.

Pulmonary rehabilitation can improve patients' quality of life.