The latest national audit of stroke services in the UK has revealed some progress in the care of patients, but also highlights key areas where more work needs to be done to ensure access to interventions and appropriate hospital assessments.
The Sentinel Stroke National Audit Programme (SSNAP), which looked at the care of stroke patients between April 2014 and March 2015, has picked up a downturn in the percentage of patients being admitted to a stroke unit within four hours, slipping to 56.8% from 58% in the previous year.
This, the report notes, is particularly concerning given that admission to specialist centres is known to be crucial to improving survival chances and reducing dependency after a stroke.
On the plus side, the percentage of stroke patients receiving a brain scan within 12 hours inched up to 88.2% compared to 84.6% a year ago, and improvements were also seen in the time between having a stroke and receiving clot-busting treatment (56 minutes versus 58 minutes), which “suggests that stroke teams in hospitals are better organised compared to last year”.
However, the audit did find that patients are less likely to receive thrombolysis within 60 minutes if they arrive at hospital ‘out of hours’, and that 32% of patients needing a swallow screen failed to receive one within four hours of arriving leaving them at risk of inhaling food and drink, highlighting room for improvement on admission assessments and subsequent procedures.
An improvement was seen in reducing age discrimination; back in 2004 older patients were much less likely to be admitted to a stroke unit than younger patients, but this now seems to have been vastly reduced, findings show.
Audit on after care
The SSNAP also published its first ever audit report on the after care of stroke survivors, which revealed much variation in the way services are organised and called for all nurses in post-acute inpatient services to be trained in swallow screening as a priority.
Other recommendations include: that all healthcare-based services provide their patients with access to a comprehensive multi-disciplinary team – including doctors, nurses and a named social worker; that people’s access to psychological support should be as important as their access to physical support services; and that all early supported discharge teams should triage and start treating patients within 24 hours of hospital discharge.
“It is worrying that the audit shows there is currently considerable and unacceptable variation in the level of treatment that stroke patients can expect,” said Alexis Wieroniey, Deputy Director of Policy and Influencing at the Stroke Association.
“It is also concerning that the psychological support statistics are very poor indeed”, showing the longest delays in waiting times with an average of over 10 weeks delay from referral to treatment, she said, also noting that one quarter of services have a waiting time of 150 days or more.
“It is clear that stroke services are under pressure to perform with limited resources…We urgently need a renewed national commitment to improve stroke treatment and care to ensure everyone touched by stroke gets the support they need to recover.”