In 2008 the NSSA carried out an audit of 224 hospitals in Britain to find out whether hospitals had followed the Guideline. The information from each hospital was collected by the hospital staff themselves, then compared to previous audits to see whether stroke service organisation had improved or not over the different rounds of the audit.
- Work with all agencies to raise the public awareness of stroke to speed up access to hospital following stroke. Ensure that the FAST test is used in diagnosis before hospital and made part of the record accessible to all hospital staff.
- Organise hospital care so that patients are admitted directly to an acute stroke unit from A&E without having to go through an admission ward or clinical decision unit and all suitable patients can be treated with thrombolysis as quickly as possible.
- Improve the training and support given to junior doctors and staff from nonstroke disciplines who undertake initial clerking of stroke patients. There should be regular quality control to ensure that documentation is complete.
- Brain scanning should be speeded up in many units. There is no excuse not to scan virtually all patients within 24 hours of admission.
- Ensure that all acute stroke units have effective multidisciplinary teams and working which includes physiotherapy, occupational therapy, speech and language therapy, dietetics and psychology.
- Find the 25% of patients who do not currently get to a stroke unit and do something for them. If a hospital cannot provide specialist care for these patients then a more effective neighbouring hospital should be commissioned to provide the care instead.
- Take urinary continence more seriously. All patients with persisting incontinence after a stroke should have a continence assessment and appropriate treatment given.
- Manage all patients so as to avoid chest infection and urinary tract infection and identify and treat infections early when they do occur.
- Communicate better with patients and relatives, particularly about the stroke diagnosis and prognosis and how to prevent further strokes.
- Make sure you give the correct advice is given to patients who drive ie that they must not drive for at least 1 month after stroke and that a return to driving is dependent on satisfactory recovery. Record this discussion in the notes.
- Royal College of Physicians of London
- Healthcare Quality Improvement Partnership
- Stroke Working Party