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12 May 2011
The final report of the National Sentinel Stroke Audit shows that care for patients with stroke is still improving 12 years after the start of the audit. 88% of patients spent at least some time on a stroke unit which is excellent progress from 74% in 2008. Patients on stroke units have better outcomes than those admitted to and treated on general wards.
The audit, commissioned by the Healthcare Quality Improvement Partnership (HQIP), was carried out on behalf of the Intercollegiate Stroke Working Party by the Royal College of Physicians’ Clinical Standards Department, and covers 100% of eligible hospitals in England, Wales and Northern Ireland.
Other significant findings from this round of the audit include:
- About two-thirds of patients spend more than 90% of their hospital stay in a stroke unit
- There are still too many patients spending the majority of their time on a general assessment unit. 57% of patients go first to general assessment units where stroke specialist care is not carried out quickly enough and therefore puts patients at risk of later complications
- Only 36% are admitted directly to a stroke unit, with 38% reaching the stroke unit within 4 hours
- 56% of patients for whom the time of first experiencing symptoms of stroke is known were admitted within 3 hours, and 64% within 4 hours. This figure is slightly worse than 2008 and suggests that the FAST advertising campaign has not had a long-lasting effect and that on-going public education is required
- Patients are not receiving enough face to face therapy. This issue, measured for the first time in this audit may reflect both professional underestimation of patients’ capacity to participate in therapy, and unavailability of the therapies themselves. A major review of therapy working practices and staffing levels is needed
- 5% of all patients in the audit sample received thrombolysis which is a major increase from 2008 (1.8%) but is still only about a third of the patients who should receive it
The National Sentinel Stroke Audit has been reporting for 12 years and was one of the first audits internationally where it was possible to obtain a clear picture of how stroke care was being delivered in every corner of the country. Its methods have been borrowed for national audits in Italy, Spain, Ireland and Australia. From 2012 onwards stroke audit will be carried out in a different way. It is likely that there will be a national prospective stroke audit, covering information needed by NICE, the Stroke Improvement Programme, Department of Health Vital Signs and the NHS Outcomes Framework.
Professor Tony Rudd, Chair of the Intercollegiate Stroke Network, said:
'Stroke care has dramatically improved since we first started measuring the quality of care 13 years ago. In many areas of management we perform as well or better than other countries in Europe and America. The National Stroke Strategy and the subsequent work undertaken by the Stroke and Cardiac Networks have been the most important factors leading to this improvement. However, there are still many aspects of care, particularly in rehabilitation and longer term management, that need to be developed. It is vital that we continue to develop national policies to encourage these changes to occur and that we also continue to monitor both processes of care and patient outcomes.'
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