Despite many improvements in stroke services over the past decade, a quarter of patients in the National Sentinel Audit for Stroke 2008 were not offered the best treatment for stroke – a stay in a dedicated stroke unit.
The audit, funded by the Healthcare Quality Improvement Partnership (HQIP), was carried out on behalf of the Intercollegiate Stroke Group by the Royal College of Physicians’ Clinical Effectiveness and Evaluation Unit (CEEu), and covers 100% of eligible hospitals in England Wales and Northern Ireland. Other significant findings from this round of the audit include:
• 29% of patients were admitted to a stroke unit on the same day as their stroke and 57% were admitted either the same day or the following day. This is a major improvement since 2006.
• 74% of patients now spend some of their time and 68% spend more than half their time on a stroke unit which is a very considerable improvement from 2006.
• Only 17% of patients are admitted to an acute stroke unit within four hours of admission.
• Use of the FAST Test (Face, Arm, Speech Test) by ambulance staff was recorded in only about a quarter of patients’ notes.
• Only 21% of patients had a brain scan within three hours where appropriate, an improvement over the last audit (16% in 2006) but nowhere near high enough if patients are to receive the best outcomes.
Although increasing numbers of centres are providing thrombolysis (anti blood-clotting drug), less than 10% of appropriate patients are receiving the drug nationally. However, service developments are likely to result in an increase in this percentage in coming years. There has been consistent improvement in performance in the nine key indicators in England over recent years, perhaps reflecting the value of a strong national stroke strategy in driving service improvements. Dr Tony Rudd, chair of the Intercollegiate Stroke Network, said: “Since the last time we looked at quality of stroke care two years ago there have been some very gratifying improvements. However, services remain patchy and in some parts of the country the chances of getting good care is low. I am optimistic that, now we have started implementing the National Stroke Strategy, these inequalities will lessen.”
