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Stroke Care Poor and Disorganised, Says Report - Urgent Change Needed
October 11, 1999Stroke is the third main cause of death and the main cause of disability in the UK, and it accounts for about 5% of the NHS budget. The National Sentinel Audit for Stroke, commissioned by the NHS Executive, examined many aspects of stroke care, including the organisation and facilities available for stroke patients; how they are diagnosed and treated; discharge planning and communication with carers; and follow-up and review of patients.
In all of these areas there were major failings. 80% of NHS Trusts with responsibility for stroke patients took part in the audit, which involved collecting data about 6,894 consecutive stroke patients. Patients managed on specialist stroke units received better care than those in general wards. This reinforces previous research, which has shown better outcomes both in terms of death and disability in stroke units. Only 50% of trusts have a specialist team for stroke and only 18% of patients spent more than half of their time in hospital in a stroke unit. Management of stroke-specific health problems was below standard in many hospitals. The audit showed that of the patients reviewed:
only 55% had their swallowing screened on admission
visual-field examinations were performed in only 44%
cognitive function tests were performed in only 23%
only 55% had rehabilitation goals agreed by the multidisciplinary team
carers' needs were assessed in only 31% of cases
only 49% of patients who went home had a review of disability at 6 months
Dr Tony Rudd, Associate Director of the Clinical Effectiveness and Evaluation Unit of the RCP, said:
"Although some hospitals were performing well, the overall results were disappointing. The key findings from the audit support the establishment of stroke units of sufficient size to be able to treat most stroke patients admitted to hospital. They need not be costly to introduce and have been shown to save lives and improve functional ability after stroke.
"A survey of patient and carer views of stroke care commissioned by the Royal College of Physicians last year also showed patients shocked at care they had received and expressing the desire to be looked after by experts in the field. It is within the power and resources of every trust in the country to organise their stroke care efficiently and effectively. There is no longer any excuse to delay such a development".
The findings from the National Stroke Audit have been used to inform the National Service Framework. The expectation that this will support organised stroke care is to be welcomed.
Royal College of Physicians
visual-field examinations were performed in only 44%
cognitive function tests were performed in only 23%
only 55% had rehabilitation goals agreed by the multidisciplinary team
carers' needs were assessed in only 31% of cases
only 49% of patients who went home had a review of disability at 6 months
Dr Tony Rudd, Associate Director of the Clinical Effectiveness and Evaluation Unit of the RCP, said:
"Although some hospitals were performing well, the overall results were disappointing. The key findings from the audit support the establishment of stroke units of sufficient size to be able to treat most stroke patients admitted to hospital. They need not be costly to introduce and have been shown to save lives and improve functional ability after stroke.
"A survey of patient and carer views of stroke care commissioned by the Royal College of Physicians last year also showed patients shocked at care they had received and expressing the desire to be looked after by experts in the field. It is within the power and resources of every trust in the country to organise their stroke care efficiently and effectively. There is no longer any excuse to delay such a development".
The findings from the National Stroke Audit have been used to inform the National Service Framework. The expectation that this will support organised stroke care is to be welcomed.
Royal College of Physicians
Stroke Current Events and Stroke News RSSNew understanding about mechanism for cell death after stroke leads to possible therapy
Scientists at the Brain Research Centre, a partnership of the University of British Columbia Faculty of Medicine and Vancouver Coastal Health Research Institute, have uncovered new information about the mechanism by which brain cells die following a stroke, as well as a possible way to mitigate that damage.
Surgery not linked to memory problems in older patients
For years, it has been widely assumed that older adults may experience memory loss and other cognitive problems following surgery. But a new study from researchers at Washington University School of Medicine in St. Louis questions those assumptions.
Pushing the brain to find new pathways
Until recently, scientists believed that, following a stroke, a patient had about six months to regain any lost function. After that, patients would be forced to compensate for the lost function by focusing on their remaining abilities.
Night Beat, Overtime and a Disrupted Sleep Pattern Can Harm Officers' Health
A police officer who works the night shift, typically from 8 p.m. to 4 a.m., already is at a disadvantage when it comes to getting a good "night's" sleep.
Vitamin B niacin offers no extra benefit to statin therapy in seniors already diagnosed with CAD
The routine prescription of extended-release niacin, a B vitamin (1,500 milligrams daily), in combination with traditional cholesterol-lowering therapy offers no extra benefit in correcting arterial narrowing and diminishing plaque buildup in seniors who already have coronary artery disease, a new vascular imaging study from Johns Hopkins experts shows.
The benefits of exercise
Physical exercise is one of the most effective methods of preventing disease. The current issue of Deutsches Arzteblatt International is devoted to this important topic.
Heart and bone damage from low vitamin D tied to declines in sex hormones
Researchers at Johns Hopkins are reporting what is believed to be the first conclusive evidence in men that the long-term ill effects of vitamin D deficiency are amplified by lower levels of the key sex hormone estrogen, but not testosterone.
New study links vitamin D deficiency to cardiovascular disease and death
While mothers have known that feeding their kids milk builds strong bones, a new study by researchers at the Heart Institute at Intermountain Medical Center in Salt Lake City suggests that Vitamin D contributes to a strong and healthy heart as well - and that inadequate levels of the vitamin may significantly increase a person's risk of stroke, heart disease, and death, even among people who've never had heart disease.
Early end to key study on benefits of niacin, a B vitamin, in keeping arteries open was premature
Heart experts at Johns Hopkins are calling premature the early halt of a study by researchers at Walter Reed Army Medical Center and Washington Hospital Center on the benefits of combining extended-release niacin, a B vitamin, with cholesterol-lowering statin medications to prevent blood vessel narrowing.
Study finds many people with hemianopia have difficulty detecting pedestrians while driving, advocates for individual testing
Schepens Eye Research Institute scientists have found that--when tested in a driving simulator--patients with hemianopia (blindness in one half of the visual field in both eyes) have significantly more difficulty detecting pedestrians (on their blind side) than normally sighted people.
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