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More than 50% of stroke victims fail to get fast treatment

Only 2% of patients get surgery within target time

Jo Carlowe

Wednesday, 22 June 2011

More than half of NHS patients with symptoms of stroke are failing to get fast access to life-saving, stroke prevention surgery.

According to the Royal College of Physicians a lack of public and professional awareness, combined with badly designed hospital services, is resulting in hundreds of preventable strokes.

Surgeons say that unless awareness is increased to a level where such patients are routinely treated as emergencies, it will not be possible to meet Government stroke care standards.

Figures from the third report of the Carotid Endartectomy Audit, commissioned by the Healthcare Quality Improvement Partnership (HQIP) and carried out by the Royal College of Physicians and the Vascular Society, published this week, show some improvement in the overall time in which patients are getting surgery of the neck arteries in order to prevent stroke (carotid endarterectomy or CEA). But the study also reveals considerable variation across the UK, with significant delays between patients experiencing symptoms, referral to stroke specialists and on to surgery.

While some patients who need surgery are accessing it within 2 days, others are waiting almost two months. Surgeons say it is vital to discover why practise is variable across the UK. There is also concern that some hospitals are failing to provide any data, meaning care quality is impossible to determine.

The National Institute for Health and Clinical Excellence (NICE) sets a timeframe of two weeks from symptoms to surgery, while the Government's National Stroke Strategy (NSS) is 48 hours. Currently 40% of NHS patients are operated on within the NICE timeframe, up from 33% last year. The report describes the NSS timeframe as 'a major challenge' with only 2% of NHS patients currently meeting these standards.

Experts predict that if all patients were operated on within 14 days as many as 200 strokes would be prevented for every 1000 operations.

Vascular Society audit chairman and consultant vascular surgeon, Mr David Mitchell said: “Despite the good work by many clinicians, this study shows that we have a long way to go if we are to meet current NICE guidance of getting 100% of patients who need surgery into the operating theatre within 14 days of symptoms. 

“Variation in the quality of care provision between Trusts highlights the need for those who are underperforming to follow the best practice of others who are proving that these standards can be achieved. We know that fast referral to TIA clinics where specialist staff can identify those at high risk of stroke, begin treatment and rapidly refer to the nearest vascular surgery unit for surgery, is absolutely vital in preventing needless strokes and deaths.'

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