Audit of stroke services suggests improvements

Audit of hospital stroke services suggests improvements

Stroke Foundation of New Zealand

Friday 4 June, embargoed to 12 midday

An audit has found New Zealanders do not have sufficient access to organised hospital stroke services. The audit also found some positives, including a better approach to the assessment of mini-strokes here, than in Australia.

Funded by the Ministry of Health and carried out by the Stroke Foundation of New Zealand in 2009, the audit looked at the provision of stroke services in hospitals in the first seven days after stroke. It was in two parts – a survey of structural and process elements of stroke provision and an audit of the care provided to stroke patients. Findings were compared with an audit of Australian hospital stroke services.

Stroke Foundation Chief Executive Mark Vivian says the audit provides a benchmark against which future developments and improvements can be compared.

“The audit found New Zealanders currently do not have sufficient access to organised acute stroke services.

“Only eight out of 21 District Health Boards provide stroke services that are consistent with international best practice, and only 39 percent of the patients in the audit received care in a stroke unit. In comparison, 51 percent of acute stroke patients in participating Australian hospitals were in stroke units.

“Throughout New Zealand there are only 83 dedicated beds in stroke units, while on the day of the audit there were 176 acute stroke patients in our hospitals.”

He says the speed with which stroke patients are treated also needs to improve.

“With most strokes, the sooner you get to hospital and begin to be treated, the better your outcome. The audit found that 67 percent of DHBs offered time-critical intravenous treatment that breaks down blood clots if commenced within four and a half hours of stroke onset. Over 80 percent of New Zealanders live within a DHB area that offers this treatment.

“However, only 3 percent of stroke patients were actually receiving this time critical treatment, the same percentage as in Australia.

“The reasons for the delay in the treatment being given are varied, and include people not recognising stroke symptoms, delays in reaching hospital quickly, less than half of DHBs having emergency department protocols for the rapid triage of stroke symptoms, and potential delays to vital tests once at hospital.

“The audit has identified our capacity to provide faster treatment, and we hope this will lead to an increase in the provision of time-critical treatment in the future.”

Mr Vivian says a positive highlighted by the audit was our assessment of transient ischaemic attacks (TIAs) or mini-strokes, with just over 80 percent of DHBs using a recognised assessment tool with TIA patients, compared with just under 40 percent of Australian hospitals.

The audit found:

• more than half the audited stroke patients were aged over 77 years

• 48 percent of patients were male and 52 percent female

• ethnicity was recorded as Maori for 13 percent and Pacific for 3 percent

• most of the patients had been independent prior to their stroke (66 percent), and 90 percent lived at home

• three-quarters were diagnosed with an ischaemic stroke

• half had multiple pre-existing stroke risk factors at the time of admission.

Recommendations include:

That District Health Boards:

• review their stroke service provision, appropriate to DHB size, against New Zealand recommendations and guidelines

• review their DHB’s stroke service provision against the key messages and results given in the audit report to identify areas where they are doing well and where they need to improve

• formulate and implement plans to address gaps in relation to organisation and provision of services

• participate in a national audit of acute services in 2011 to enable ascertainment of the standard of service or improvement where required.

That the Stroke Foundation:

• seeks funding to partner with the National Stroke Foundation (Australia) to offer DHBs the opportunity to participate in a national audit of acute services in 2011, thus enabling a clear indication of progress in the provision of services to people with stroke

• facilitate the utilisation of recognised protocols by supporting the development of clinical networks; and by sourcing a ‘bank’ of protocols suited to small, medium and large DHBs, and making these available on the Stroke Foundation website for DHBs to adopt and adapt.

That the Ministry of Health:

• targets implementation of the 2010 New Zealand stroke guideline to priority areas identified in the 2009 National Acute Stroke Services Audit

• funds the Stroke Foundation to offer DHBs the opportunity to participate in a national audit of acute services in 2011.

ENDS

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