Age and Ageing Advance Access originally published online on July 18, 2007
Age and Ageing 2007 36(5):598; doi:10.1093/ageing/afm084
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Stroke outcomes: depend on time, place and person
SIR—Rudd and colleagues [1] have shown from the results of 2004 sentinel stroke audit that older patients received sub-standard care following stroke. Other vascular risk factors were discussed with patient or carer in 56% of cases in stroke units and 39% where there was no stroke unit. The same year, we conducted a random audit of 50 case notes for patients above 65 years of age, who were followed up within 3 months after a stroke at a teaching hospital (Leeds General Infirmary). All 31 stroke unit treated patients received lifestyle advice (on alcohol, diet, smoking, and exercise). This was documented only in one case note out of 19 patients treated in a general medical ward.The results of the 5th round National Sentinel Stroke Audit are now published [2]. There is considerable improvement regarding stroke care. The number of hospitals with stroke units have increased from 79% in 2004 to 91% in 2006. Similarly, the proportion of stroke patients admitted to a stroke unit at some point have increased from 46 to 62% and patients spending over 50% of their hospital stay in stroke unit increased from 40 to 54% over the same period.
There is bad news as well! The number of patients who had CT scans within 24 h has dropped from 59% in 2004 to 42% in 2006. This can partly be explained by more stringent standard in the last round of audit. However, the results are unacceptably low and drastic measures need to be taken to achieve 100% target by 2008.
Our experience in Mid Yorkshire Hospitals NHS Trust is an encouraging one. During the audit in 2006 there was a stroke unit only in one of the three hospitals. Now we have either an acute stroke unit or a stroke rehabilitation unit at each site. We have started a rapid access neurovascular clinic jointly run by a stroke physician, a neurologist and a geriatrician. Patients referred from primary and secondary care are reviewed within a week in this clinic.
Doctors O'Connel and Gray found that the standards of care varied during the week with Wednesday being the best and Monday being worst for stroke patients [3]. Stroke does not recognise place, person, time of the day or day of the week! Although stroke care has improved over recent years we still have a long way to go.
1 Mid Yorkshire Hospitals NHS Trust, Pontefract General Infirmary, Friarwood Lane, Pontefract, West Yorkshire WF8 1PL, UK
2 Mid Yorkshire Hospitals NHS Trust, Pinderfields General Hospital, Aberford Road, Wakefield, West Yorkshire WF1 4DG, UK
3 Leeds Teaching Hospital NHS Trust, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire LS1 3EX, UK
* To whom correspondence should be addressed Email: abhaylopa{at}yahoo.co.uk
References
- Rudd AG, Hoffman A, Down C, Pearson M, Lowe D. Access to stroke care in England, Wales and Northern Ireland: the effect of age, gender and weekend admission. Age Ageing (2007) 36:247–55.
[Abstract/Free Full Text] - 10 May 2007 date last accessed. www.rcplondon.ac.uk/pubs/books/stroke/index.htm.
- O'Connel JE, Gray CS. Why stroke patients don't like Monday (or Saturdays or Sundays). Age Ageing (2007) 36:242–4.
[Free Full Text]
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