Facilities for stroke patients should match those of heart patients

People who have had a stroke need and deserve similar facilities for monitoring and care to those who have had a heart attack. All acute hospitals have coronary care units, but not all hospitals have stroke units.

Results from the 2004 National Sentinel Audit of Stroke show that more hospitals have a stroke unit than ever before, but that 39 more are needed. Of those hospitals who had a stroke unit at the time of the last audit in 2002, most have not expanded and the total number of stroke beds is only half that needed.

Progress has been slow in other areas such as acute stroke care, numbers of nurses caring for stroke patients, and availability of patient information. There is concern that standards in rehabilitation units may be deteriorating as more attention is paid to acute stroke care. While there has been steady progress in many elements of hospital care - the hospitals which performed the worst in the last audit in 2002 have improved the most – there has been little matching development in community services.

The audit, which covers hospitals in England, Wales and Northern Ireland, this year measures the organization and facilities available for stroke patients and not direct patient care. It is funded by the Healthcare Commission and prepared on behalf of the Intercollegiate Stroke Group by the RCP’s Clinical Effectiveness and Evaluation Unit. The next patient care audit will report in Spring 2005. Key messages from this audit:

• 82% of hospitals in England have a stroke unit, this is up from 73% two years ago, and is a major achievement for the health service as there were virtually none 10 years ago. Not only are the numbers increasing, but there is also evidence of improving quality of care within the units. Wales, which has not had the equivalent of a National Service Framework dealing with stroke has fared much less well with only 45% of hospitals having a stroke unit
• There is no excuse for the remaining 18% (39 hospitals) not to have a stroke unit - more work needs to be done to encourage Trusts to develop stroke services. It wouldn't be acceptable to have an acute hospital without a coronary care unit – the provision of stroke units should be equally important
• We need to take acute stroke care much more seriously. Although there are an increasing number of hospitals with acute stroke units, only 56% of these units are able to provide continuous physiological monitoring. Stroke patients need similar facilities to heart patients
• The most common complaint that patients make about NHS stroke care is that they feel abandoned when they leave hospital. Only 27% of hospitals in England and 5% of hospitals in Wales have specialist community stroke teams
• Two-thirds of hospitals have a neurovascular clinic for the management of patients who have Transient Ischaemic Attacks (TIA). Only half of these are able to see and investigate patients within 14 days by which time a sizeable number will already have developed a stroke

Dr Tony Rudd, Chair of the Intercollegiate Stroke Group, said: “Much has been achieved in improving hospital stroke care over the last few years. However, the few laggard hospitals that have failed to provide a specialist stroke service need urgent help to change. Now that the final date for the milestones in the NSF for Older People has passed we must not lose the momentum of the last few years and allow mediocrity in some parts of the National Health Service to continue.”

Dr Mike Pearson, Director of the RCP’s Clinical Effectiveness and Evaluation Unit, said: “Measurement matters! The reliable and respected data collected in the national stroke audit have identified deficiencies and it is excellent to see the dramatic changes for the better in stroke care. Because most acute hospitals can provide good care – there is no reason why the rest cannot do so too. The new challenge is to improve the aftercare of stroke within the community – so that we minimise long term deficits and help patients attain their maximum level of independence.”

Professor Ian Philp, National Director for Older People, said: “I would like to congratulate the units on the work that has been done. An enormous amount has been achieved in the care of people with strokes. I welcome the report which highlights what has been achieved and which alerts us to the work that is still needed if we are to ensure people who suffer strokes receive the care they deserve.”

Helen Laing, the Healthcare Commission’s National Clinical Audit Commissioning Manager, said:“This information is of great value and demonstrates the importance of clinical audit in promoting better outcomes for patients. It also tells us to what extent national guidelines have been implemented. We can see that, while the number of hospitals who have dedicated stroke units has improved, there is still some way to go. We hope that next years' audit will show even greater improvements.”