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Published on: January 15, 2017
British Association of Stroke Physicians: benchmarking survey of stroke services
Helen Rodgers1, Martin Dennis, David Cohen
1School of Population and Health Sciences (Epidemiology and Public Health), The Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH, UK. helen.rodgers@newcastle.ac.uk
Insights
Developing specialist stroke services in UK hospitals is crucial but requires significant improvement to meet national targets. Many stroke units lack adequate staffing and specialist training opportunities, impacting patient access to expert care.
Area of Science:
- Neurology
- Public Health
- Healthcare Management
Background:
- The National Service Framework for Older People mandates specialist stroke services in UK general hospitals by 2004.
- This initiative aims to improve care quality and outcomes for stroke patients.
Purpose of the Study:
- To delineate the organizational structures and staffing models of specialist hospital-based stroke services across the UK.
- To assess the implementation status of the National Service Framework's stroke care targets.
Main Methods:
- A national postal survey was conducted among consultant members of the British Association of Stroke Physicians (BASP).
- Data collected focused on neurovascular clinics, acute stroke units (ASUs), and stroke rehabilitation units (SRUs), including their organization and staffing.
- Response rate achieved was 72% (91 out of 126 consultants).
Main Results:
- The survey identified 54 neurovascular clinics, 40 ASUs, and 68 SRUs.
- Only 50% of ASUs typically admitted stroke patients within 24 hours.
- Significant limitations in training opportunities were noted, with 37% of ASUs and 82% of SRUs lacking specialist registrars.
- Therapy session availability per bed per week on SRUs was low: physiotherapy (0.8), occupational therapy (0.6), and speech and language therapy (0.25).
Conclusions:
- Substantial development is required for UK hospital-based stroke services to meet National Service Framework targets.
- Many healthcare trusts lack comprehensive stroke service components, and not all stroke patients receive specialist care.
- Limited training opportunities for stroke specialists and lower-than-expected therapy staffing levels in stroke units hinder optimal patient care.
Background:
the National Service Framework for Older People requires every general hospital which cares for stroke patients to introduce a specialist stroke service by 2004.
Objective:
to describe the organisation and staffing of specialist hospital-based stroke services in the UK.
Design:
a national postal survey of consultant members of the British Association of Stroke Physicians (BASP) seeking details of the provision of neurovascular clinics, acute stroke units (ASUs), stroke rehabilitation units (SRUs), and the organisation and staffing of these services.
Results:
the response rate was 91/126 (72%). Fifty-four neurovascular clinics, 40 ASUs and 68 SRUs were identified. Neurovascular clinics used a number of strategies to maintain rapid access and 30 (56%) were run by a single consultant. Only 50% ASUs usually admitted patients within 24 h of stroke. As the number of beds available on ASUs and SRUs did not reflect the total number of stroke in-patients, 21 (53%) ASUs and 45 (79%) SRUs had admission criteria. Training opportunities were limited: 37% ASUs and 82% SRUs had no specialist registrar. The therapy sessions (1 session=half a day) available per bed per week on a SRU were: physiotherapy 0.8; occupational therapy 0.6; speech and language therapy 0.25.
Conclusions:
significant development is needed to achieve the NSF target for hospital-based stroke services as few Trusts currently have all components in place and even when available not all stroke patients have access to specialist care. Stroke specialists will be required to run these services but training opportunities are currently limited. Stroke unit therapy staffing levels were lower than was available in randomised controlled trials.
