Hospitals struggle to cope with stroke care, says royal college

BMJ 2002; 325 doi: (Published 27 July 2002) Cite this as: BMJ 2002;325:179
  1. Anne Gulland
  1. London

    Hospitals in the United Kingdom are struggling to meet the spiralling demand of caring for patients with stroke, with only a third of patients ever entering a dedicated unit, says a report by the Royal College of Physicians.

    The third national sentinel audit of stroke, for 2001-2, found that just 36% of stroke patients spend any of their hospital stay in a stroke unit—despite the fact that almost three quarters of hospitals (73%) in England, Wales, and Northern Ireland have a stroke unit.

    This figure is an improvement on previous years, with just 45% of hospitals having a stroke unit in 1998 and 56% in 1999. But the audit warned that the “number of allocated beds remains inadequate and cannot meet the demand.”

    Every year some 130000 people in the United Kingdom have a stroke—a number that is increasing with an ageing population. Penny Irwin, stroke programme coordinator at the royal college, said that the national service framework on older people, which included targets for stroke care, had led to an increase in the number of stroke units.

    “The national service framework has helped, but the concern is that the funding hasn't been put behind it,” she said.

    “Stroke had been ignored until 1993, when research done by Peter Langhorne and colleagues [Lancet 1993;342:395-8] showed that the only thing that really worked were stroke units. This research showed better outcomes both in terms of mortality and disability.”

    The authors of the audit also described the data on assessment of individual patients as “depressingly low.” Just 64% of patients have an assessment of swallowing, 63% have a visual field assessment, and only 49% are weighed.

    Ms Irwin added that rehabilitation of patients after discharge was vital, but a shortage of therapists was threatening this.

    The report also warned that there was a shortage of full time stroke doctors. Some eight out of 10 trusts have a consultant with responsibility for stroke, but most of these doctors spend just eight hours a week with stroke patients. An extra 385 full time equivalent stroke doctors are needed in England and Wales to cover the gaps, it says.

    Embedded Image

    Patients at the stroke rehabilitation group, Rochford Hospital, Essex

    (Credit: ULRIKA PREUSI)

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