Audit highlights repeated failure to admit stroke patients to specialist units

There has been a “constant failure” to meet the target of 90 per cent of patients with a stroke being admitted to a stroke unit, according to the Irish National Audit of Stroke National Report: A critical review of national stroke data for Ireland from 2013 to 2021.

The report shows there was an increase in the proportion of patients with a stroke admitted to a stroke unit from 65 per cent in 2013 to 70 per cent in 2021.

However, this is below the 90 per cent target contained in the national stroke strategy.

The lack of stroke unit bed availability was the main factor for non-admission to a stroke unit throughout the period, according to the report.

There was also an increase in the proportion of the total hospital stay spent in a stroke unit, from 57 per cent in 2013 to 68 per cent in 2021; however, this too remains “far below” the 90 per cent target.

This report analysed data on 34, 630 patients with stroke admitted to hospital between 2013 and 2021. Over the nine-year period, there has been a 23 per cent increase in stroke admissions with a reduction in the proportion of patients aged 80 years and older and an increase in patients aged 64 years and younger.

The data show there has been a 29 per cent reduction in mortality for ischaemic stroke.

Launching this year’s report, Prof Joe Harbison, Clinical Lead, Irish National Audit of Stroke, said: “Our analysis of data from nine years has shown slow but significant areas of improvement in many areas and improved organisation and delivery of care in hospitals even through the challenges of the pandemic. It’s clear however that challenges still exist and key performance indications such as being admitted to a stroke unit, or having swallow assessed on admission, are still not being achieved in too many cases. The analysis has also shown the importance of reinforcing public education about recognizing the symptoms of stroke as delays to presentation to hospital are gradually increasing and ‘time is brain”.”

Other key findings were:

·       The proportion of patients who saw a doctor within 10 minutes of arrival at hospital increased from 23 per cent in 2016 to 48 per cent in 2021

·       The proportion of patients who had brain scan within 1 hour of arrival at hospital increased from 20 per cent in 2013 to 48 per cent in 2021

·       The IV thrombolysis rate decreased from 11 per cent in 2013 to 10 per cent in 2021.  This could be increased if people arrived in hospital as soon as possible.

·       The thrombectomy rate has increased from 4.8% in 2016 to 9.5% in 2021

·       The median hospital length of stay has reduced from 11 days in 2013 to eight days in 2021

·       There was an increase in the proportion of patients discharged home with early supported discharge from two per cent in 2017 to 10 per cent in 2021.

The audit report was launched at the National Office of Clinical Audit Conference, which is taking place in the RCSI.