Results of the NOCA Irish National Audit of Stroke Report 2019 shows that less than half of all patients suffering from stroke present to hospital quickly enough to receive emergency treatments.
Prof Joe Harbison, Clinical Lead on the Irish National Audit of Stroke (INAS) today launches the first INAS Report 2019 at a virtual meeting hosted by the National Office of Clinical Audit. The Irish National Audit of Stroke (INAS) is a clinically led quality audit which measures the quality of stroke care, as well as the structure of stroke services, provided to patients in hospitals that admit acute stroke patients. There are 25 hospitals in Ireland participating in this audit. Activity within the participating hospitals is measured against evidence based standards to help improve the standard of acute stroke care.
Launching this year’s report, Prof Joe Harbison said “Stroke remains the third leading cause of death in Ireland and Western Europe, and the leading cause of severe, adult-onset physical disability. This report will benefit stroke services in Ireland to review quality and allow for improvements across acute stroke care. This audit points to the need for investment in more designated stroke unit beds to meet our key performance indicators (KPIs). It also highlights the need for patients to go to hospital as soon as possible when experiencing stroke symptoms. “Time is brain””.
KEY FINDINGS
- Treatment of acute stroke is time dependent, but less than half of cases (49%, n=1103) arrived at hospital within 3 hours of onset of stroke symptom. This is a decrease from 53% in 2017 and means that patients are less likely to receive acute treatments such as thrombolysis
- Thrombolysis is the breakdown of blood clots formed in blood vessels using medication. It can only be given within 4.5-hours of onset of stroke symptoms. In 2019, 10.6% of patients with ischaemic stroke had treatment with thrombolysis.
- Thrombectomy (EVT) is a procedure where large clots can be removed from arteries in the brain. In 2019, 9% of patients with a stroke had a thrombectomy. The rate of thrombectomy in Europe is 2%.
- The median time from hospital arrival to contact with the medical team was 17 minutes and the national median ‘door to imaging’ (DTI) time for all patients with a stroke was 1 hour and 20 minutes.
- 71% of patients were admitted to a stroke unit with the median length of stay being 8 days.
- 72% of patients with ischaemic stroke and 62% of patients with haemorrhagic stroke had disabilities on discharge. Only 5% of patients were referred to Early Supported Discharge.
- Mortality rate for ischaemic stroke mortality is 9% (n=270) and 31% (n=157) in haemorrhagic stroke.
Overall, the report highlights the sustained improvements that have been made in caring for patients with a stroke, but it also identifies continued challenges and limitations in specific areas of care, as well as some worrying signs of regression in some areas, such as delays in presentation to hospital after the onset of stroke symptoms.
Martin Quinn, Public Representative on the INAS Audit added “This report being launched today gives me great hope for the future and for the improvement of care, and of services for those who suffer a stroke in Ireland. The many positive aspects in relation to developments in improving stroke care in hospitals throughout the country is to be welcomed. There is also of course much to be worked on as you can see from the recommendations in the report, some of which will undoubtedly require additional resources and investment. What is clear though is that if implemented these recommendations will greatly improve outcomes for stroke survivors.”
INAS will undertake an organisational audit of stroke services, and this will be repeated biennially. This audit will examine the organisation of acute stroke services, including the environment, staffing levels, availability of imaging and interventions, and pathway on discharge.
Copies of the report will be available to download from www.noca.ie.
