The content of this website is intended for healthcare professionals only

Stroke patients still not getting care they need

Care has improved in some respects but patients still miss key interventions and assessments

Louise Prime

Wednesday, 02 December 2015

Stroke care has improved steadily in some respects, and age discrimination has been vastly reduced, but patients are still missing out on important interventions and assessments on hospital admission so further improvements are needed, according to the latest official audit. It also found that the proportion of people being admitted to a specialist stroke unit within the first crucial 4 hours of a stroke actually went down over the past year.

The latest report from the Sentinel Stroke National Audit Programme (SSNAP) examined what happened to people who had had a stroke between April 2014 and March 2015 in England, Wales and Northern Ireland; the audit was led by the Royal College of Physicians’ Clinical Effectiveness and Evaluation Unit (CEEu) on behalf of the Intercollegiate Stroke Working Party. The auditors measured both processes of care provided to stroke patients, and also the structure of stroke services (for example, staffing levels). They evaluated important interventions such as thrombolysis, and the range of specialist assessments that patients should have before discharge.

They found that although some improvements in care had been made, there were still significant problems:

  • There was a ‘concerning’ reduction in the proportion of patients admitted to a specialist stroke unit within 4 hours, down to 56.8% from 58% the previous year, despite evidence that admission to such a unit in the first four hours is crucial in reducing mortality and dependency after a stroke.
  • Compared with the previous year, more patients this year had a brain scan within 12 hours (88.2% compared with 84.6%); and the time between stroke and thrombolytic treatment was cut from 58 minutes to 56 minutes. The authors said this might show that stroke teams had become better organised than they were last year.
  • There was also an improvement in the proportion of people who had a swallowing screen, if needed, within 4 hours of getting to hospital (up from 64% last year to 68% this year) – so fewer patients are now at risk of inhaling solids and liquids.
  • In 2004 older people were less likely than younger patients to be admitted after a stroke, but the authors said: “Age discrimination in stroke units has been vastly reduced, if not eliminated.”
  • Although the number of people missing out on a necessary continence plan within three weeks of stroke has improved from five in 20 last year to three in 20 now, the report described this as “still unacceptably high”.

SSNAP also this morning published its first ever audit report on the organisation of care for stroke survivors once they leave hospital, which revealed the need for all stroke patients to have access to comprehensive multidisciplinary teams, as there is a variation in the way services are organised. It also raised concerns about the number of nurses within post-acute inpatient services who are not trained in swallow screening, which SSNAP pointed out is a key competency when treating stroke patients.

Dr Geoffrey Cloud FRCP, associate director for stroke (CEEu), said: “This report gives new and important information about the standard of stroke care outside hospitals nationally. In doing so, it provides valuable recommendations to improve standards for all those involved in providing and commissioning community stroke care. As with hospital care, services outside hospitals are under increased pressure for further availability of services and improvement. We hope that this report can be used in a practical way to help influence positive change.”

Registered in England and Wales. Reg No. 2530185. c/o Wilmington plc, 5th Floor, 10 Whitechapel High Street, London E1 8QS. Reg No. 30158470