Admissions to stroke units 20% lower than target, audit finds

The proportion of patients admitted to stroke units is almost 20 per cent lower than the national target of 90 per cent, a clinical audit has found.

However, the audit also noted improvements in stroke-related fatality and a reduction in waiting times before treatment.

The Irish National Audit of Stroke 2020 report, published on Wednesday, said there are about 6,000 strokes admitted to Irish hospitals a year, with the report analysing data on 5,153 stroke patients.

While stroke is looked upon as a disease of the older person, more than a quarter of the cases were aged under 65 years, while 57 per cent of all cases were male.

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Time is important when it comes to the treatment of stroke, however only 50 per cent of patients arrived at hospital within three hours of its onset.

The median waiting time after arriving at a hospital before contact with a doctor was 11 minutes in 2020, which was six minutes faster than in 2019, the audit found.

The median time from arrival at hospital to brain scan was one hour and three minutes, 17 minutes faster than in 2019, while mortality reduced from 12 per cent in 2019 to 11 per cent in 2020.

Seventy-one per cent of ischaemic stroke cases had disabilities on discharge.

Fifty-nine per cent of patients were discharged home, up from 56 per cent, with a further 7 per cent provided with early supported discharge, which is stroke-specific rehabilitation in the home rather than in hospital.

Thrombolysis is the breakdown of blood clots formed in blood vessels using medication. The thrombolysis rate was 10.6 per cent, which is similar to the figure in 2019, but could be increased if people attended hospital as soon as possible.

Furthermore, 8.6 per cent of all ischaemic stroke patients had a thrombectomy, a procedure where large clots can be removed from arteries in the brain. The current thrombectomy rate in Europe is 1.9 per cent.

However, in his foreword of the report, Prof Peter Kelly, consultant stroke neurologist, said what was "most concerning" was that the proportion of patients admitted to stroke units remains stalled at 71 per cent, unchanged over several years, and well below the national target of 90 per cent.

“Stroke units have proven benefits for all stroke patients to reduce death and disability by as much as one-fifth. The current situation is likely to reflect capacity constraints within the acute hospital system,” he said.

“Sustained focus and resourcing is needed to increase stroke unit capacity nationally.”

Prof Kelly also said that delays remain common among patients transferred from other hospitals for emergency thrombectomy, a time-sensitive procedure for patients with severe stroke.

“More work needs to be done to streamline processes to reduce these delays,” he added.

Prof Joe Harbison, clinical lead for the audit, said this years' report is the largest and most complete that has been produced in the past 10 years.

“It shows continued improvement in some areas, especially in getting patients to urgent treatment faster. In other areas, such as admission to stroke units and provision of therapies, substantial room for improvements remain,” he added.