Care for stroke patients 'flawed'

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A quarter of stroke patients are still not given best treatment - a stay in a dedicated stroke unit - an audit shows.

The Royal College of Physicians found improvements in stroke care in England, Wales and Northern Ireland.

But it also found many patients were still not receiving the rapid attention and diagnostic tests recommended to minimise the risk of serious damage.

A government expert said the National Stroke Strategy, introduced in 2007, needed more time to take full effect.

Services remain patchy and in some parts of the country the chances of getting good care is low Dr Tony RuddRoyal College of Physicians

It is well established that prompt and expert medical care is crucial to minimising the impact of a stroke.

But the audit found only 29% of patients were admitted to a stroke unit on the same day as their stroke, and only 57% within two days.

However, this was a big improvement since the last audit in 2006.

Only 17% of patients are admitted to an acute stroke unit within four hours of admission.

Assessment

Use of the FAST test (Face, Arm, Speech Test) by ambulance staff was recorded in only about a quarter of patients' notes.

FAST TEST FOR STROKE An assessment of three specific tell-tale signs of a stroke:Facial weakness: Can the person smile? Has their mouth or eye drooped?Arm weakness: Can the person raise both arms?Speech problems: Can the person speak clearly and understand what you say?If there are signs of problems then, it is Time to call 999

Only 21% of patients had a brain scan within three hours where appropriate to determine the extent of damage, and likelihood of further problems.

Again this was an improvement on 2006, but way short of what experts consider to be a desirable level.

The audit also found over a quarter of patients were not screened for swallowing difficulties within 24 hours, 20% have no record of visual field testing and 15% no record of sensory testing.

The researchers also expressed concern that too many patients are being moved too quickly into nursing homes directly from hospital.

They warned that access to intensive rehabilitation in care homes can be limited, and patients may be denied this vital part of their treatment, which they should expect to receive before going into residential care.

However, the audit said there had been marked improvements in some areas, including the speed of assessment by therapists after admission to hospital.

Patchy care

Dr Tony Rudd, who worked on the audit, said: "Since the last time we looked at quality of stroke care two years ago there have been some very gratifying improvements.

"However, services remain patchy and in some parts of the country the chances of getting good care is low."

Joe Korner, of the Stroke Association, said the audit showed signs of encouraging improvement.

But he said: "We need to see acceleration in the progress that is being made, and a step change in those areas which are still not providing the quality of treatment that everyone who has a stroke deserves."

Professor Roger Boyle, National Director for Heart Disease and Stroke, said many improvements had been put in place, including local stroke networks.

But he added: "The national stroke strategy is a 10-year plan, and there are no simplistic quick-fixes to the improvements we want to see - there is still a long way to go."