However, only 29% of patients are admitted directly to a stroke unit; while just one hospital in Ireland has access to a specialist community stroke rehabilitation team.
A stroke unit is a special ward in a hospital where stroke patients are cared for by a team of all professionals (a multidisciplinary team) who specialise in stroke care. Research has shown that stroke patients treated on a stroke unit do better than those treated on medical wards or general assessment units. Patients are more likely to survive the stroke, have fewer disabilities and be able to live independently if treated on a stroke unit.
The study showed that in-hospital mortality has been reduced from 19% to 14%, whilst eight per cent of patients are now being discharged to nursing homes, compared to 15% in 2008 when the previous national audit was conducted.
Around 7,000 are hospitalised due to stroke here each year. The death toll of just below 2,000 makes stroke Ireland’s third biggest killer disease after cancer and heart disease.
The improvement in outcomes has been driven by the HSE’s National Stroke Programme, which has led to a reorganisation of acute stroke services in Ireland, increasing the number of hospitals with stroke units from one to 21, and raising the rate of potentially lifesaving thrombolysis (clot-busting) treatment tenfold to 11% – one of the highest national rates in the world – in the wake of the Irish Heart Foundation’s FAST campaign.
Despite the Programme’s success in developing services, many stroke deaths remain preventable, whilst a high proportion of stroke survivors continue to suffer undue disability in terms of both severity and length of time due to inadequate rehabilitation services.
“The audit shows encouraging improvement in many areas of stroke care that has been achieved in the midst of the worst economic crisis in the history of the State, a rapidly contracting health service and just a small amount of dedicated financial resource,” said National Stroke Programme co-lead Professor Joe Harbison, who led the audit along with, Dr Paul McElwaine and project manager Joan McCormack of the Irish Heart Foundation.
Despite progress only about half of patients are getting “the most basic standard”
Prof Harbison continued: “But the progress made cannot take away from persistent substantial deficits in services. The study shows that only about half of patients are admitted to a stroke unit at any time during their hospital stay.”
Treatment in a stroke unit is the most basic standard in the care of stroke patients and substantially improves the chances of independent recovery after a stroke.
Prof Harbison said there is also a large deficit in the availability of rehabilitation services to stroke patients with few receiving the level of any therapy recommended in national and international guidelines. And whilst half of stroke survivors suffer anxiety, depression, or severe psychological distress, access to services was limited to just two hospitals nationally.
He concluded that there had been little additional investment in stroke care since the National Stroke Programme was established: “To maintain the improvements and to progress care of our fellow citizens suffering stroke to a level commensurate with a modern Western country, further investment in stroke services is undoubtedly necessary.”
Irish Heart Foundation Head of Advocacy, Chris Macey said the results reveal huge progress from a low base in the development of acute stroke services. But given that only around half of patients were receiving the benefit of the service improvements, it was reasonable to assume that many patient deaths from stroke in Ireland were entirely preventable.
In addition, whilst more people than ever were surviving stroke, in-hospital rehabilitation service levels were grossly inadequate and community rehabilitation provision was even worse.
This was exemplified by audit results showing just one hospital in Ireland has access to a specialist community stroke rehabilitation team and only three have a hospital/community stroke liaison worker.
More people are returning home after stroke than ever before due to reductions in death and discharge to nursing homes.
Mr Macey said: “But after they pass back through the hospital gates most are effectively being abandoned. We need extra investment to ensure that nobody who has a stroke in Ireland dies because services fail to meet minimum standards. And we need to develop rehabilitation services to ensure that the recovery of patients is not squandered after so much skill and commitment is deployed to save their lives.”
Prof Harbison added that Early Supported Discharge teams are currently operating from just four hospitals nationwide, despite strong evidence of their effectiveness in reducing length of hospital stay. This now stands at 22.4 days according to the audit, which although a week less than in 2008 is still around a week longer than in the UK.
He also called for greater investment in the new clot retrieval therapy, thrombectomy, which Irish doctors have helped to pioneer and which trials show could reduce death and severe permanent disability from stroke by 50%.
A stroke unit is a special ward in a hospital where stroke patients are cared for by a team of all professionals (a multidisciplinary team) who specialise in stroke care.
The core team usually consists of doctors, nurses, physiotherapists, occupational therapists, speech and language therapists, dieticians, therapy assistants, psychologists and social workers.
Research has shown that stroke patients treated on a stroke unit do better than those treated on medical wards or general assessment units. Patients are more likely to survive the stroke, have fewer disabilities and be able to live independently if treated on a stroke unit.
The essential components of care patients receive in the stroke unit include monitoring of body temperature, blood pressure, oxygen levels and blood sugars, attention to fluid intake and early mobilisation and physiotherapy.
The other main features are the use of setting goals with patients, multidisciplinary meetings and information and education for both patients and staff. In addition, there are tried and tested methods of dealing with complications and other problems arising from strokes.
The 2015 National Stroke Audit is the second audit of stroke services, following the Irish National Audit of Stroke Care 2008.
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