UK stroke performance still improving after 12 years of scrutiny

BMJ 2011; 342 doi: (Published 12 May 2011) Cite this as: BMJ 2011;342:d2993
  1. Adrian O’Dowd
  1. 1London

Patients experiencing a stroke are getting better care in the UK after more than 12 years of scrutiny, according to the latest and final National Sentinel Stroke Audit.

More needs to be done, however, to continue the steady improvement since the first audit was published in 1998, says the National Sentinel Stroke Audit 2010: Round 7 published on 12 May.

The new audit, which looked at the process of stroke care for 11 353 patients admitted to hospitals between 1 April and 30 June 2010, in England, Wales, and Northern Ireland, found that 88% of patients spent some time on a stroke unit—a rise from 74% in 2008—where patients have better outcomes than those admitted to general wards.

About two thirds of patients spent more than 90% of their hospital stay in a stroke unit, according to the audit.

Mortality rates are also improving as the audit showed the number of people dying in the first month from stroke had fallen from 24% to 17% between 2004 and 2010.

Getting the patient to the most appropriate site for treatment, however, is still far from ideal as the audit found more than half (57%) of patients went to general assessment units first.

It was “very disappointing,” said the authors, that only 36% of patients were admitted directly to an acute or combined stroke unit (up from 29% in 2008) and only 38% within four hours of arrival in hospital.

More than half (56%) of patients, for whom the time of first experiencing symptoms of stroke was known, were admitted within three hours and 64% within four hours.

The audit says this figure is slightly worse than 2008 and suggests that the FAST (Face Arms Speech Test) public advertising campaign used to screen for the diagnosis of stroke has not had a long lasting effect.

A minority (5%) of all patients in the audit sample received thrombolysis, up sharply from just 1.8% in 2008, but this was still only about a third of the patients who should receive it, said the authors.

The audit was carried out on behalf of the intercollegiate stroke working party by the Royal College of Physicians’ clinical standards department.

It now uses nine key interventions (originally there were 12) to measure performance and the report says: “Only 32% of patients received all nine of the original key interventions and only 16% received all of the 12 interventions.

“These data show that we have a lot of work still to do to ensure that care is uniformly good for all patients in all hospitals at all times.”

From next year there is likely to be a national prospective audit of stroke that will be similar to the Myocardial Ischaemia National Audit Project (MINAP), which is currently run by the National Institute for Clinical Outcomes Research in London in conjunction with the British Cardiac Society. It is hoped it will collect a minimum dataset for every patient that will provide commissioners and all the relevant agencies, such as the National Institute for Health and Clinical Excellence, the Stroke Improvement Programme, Department of Health Vital Signs and the NHS Outcomes Framework, with the data they need to commission and monitor the quality of stroke care provided in hospital and subsequently in the community.

Tony Rudd, chair of the intercollegiate stroke network, said: “Stroke care has dramatically improved since we first started measuring the quality of care 13 years ago.

“The National Stroke Strategy and the subsequent work undertaken by the stroke and cardiac networks have been the most important factors leading to this improvement. However, there are still many aspects of care, particularly in rehabilitation and longer term management, that need to be developed.

“It is vital that we continue to develop national policies to encourage these changes to occur.”


Cite this as: BMJ 2011;342:d2993


  • National Sentinel Stroke Audit 2010: Round 7 is at

  • See also BMJ 2011; 342:d744 doi:10.1136/bmj.d744.

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