Acute stroke unit admissions ‘inadequate’ —National Stroke Register Report

Published recently by the HSE, the report states that just 69 per cent of stroke patients were admitted to a stroke unit in 2017.

The report states that admission rates to an acute stroke unit were “inadequate”, adding that this highlights the need “for both a stroke unit capacity review and a stroke unit accreditation process”.

Admission to a stroke unit, staffed by appropriate specialists, is significant, as it has been shown to decrease the rates of mortality and morbidity after stroke, the report notes. 

A trend towards delayed hospital arrival in rural areas — more than three hours in eight hospitals — is also revealed in the report.

The finding supports the need for greater public awareness initiatives, such as the FAST campaign, according to the report.

Around 75 per cent of strokes occur in people aged over 65 years. The proportion of strokes occurring in men of working age increased slightly, from 26 per cent in 2016, to 28 per cent last year.

As part of a number of recommendations outlined by Prof Rónán Collins, Clinical Lead, National Stroke Programme, the report calls for a “sustained public health campaign on stroke” to help improve patient presentation times to hospital after symptom onset, which remain poor.

The report found that thrombolysis rates, at around 12 per cent, remain low in some hospitals, but states this is impacted by delayed presentations to hospital.

Door-to-CT remains challenging and needs ongoing quality improvement focus in hospitals, while the definition of stroke and stroke mortality require “universal agreement”, the report states.

On a more positive note, the data coverage of the national register, which is maintained by clinical nurse specialists and advanced nurse practitioners, is improving.

However, the register requires “appropriate professional governance structures” to ensure it is GDPR-compliant and that it can become a “sustainable professional audit” in the future.

Some 19 acute public hospitals met the register criteria and the sample size obtained for analysis was 3,481, similar to 2015 and 2016.