Guideline recommendations for the management of patients admitted with acute stroke: implications of a local audit

To assess the feasibility of implementing the New Zealand guideline for management of stroke by auditing the gap between recommended care and that provided in Hawke's Bay Hospital (HBH).

Fifty randomly selected records of patients discharged with acute stroke between 1 June and 30 November 2003 were retrospectively reviewed using an audit tool developed from the guideline.

Eight patients (16%) with non stroke syndromes were incorrectly diagnosed or coded as stroke on the basis of computed tomography (CT) scan reports. Brain imaging compliance was 100%; 86% within first 48 hours. Aspirin use or documented contraindications occurred in 62% patients within 48 hours, although the delay after imaging averaged 12.55 hours. At discharge, aspirin compliance was 100% in the surviving 42 patients. Twenty-nine (69%) patients were discharged on antihypertensive therapy, but two patients were readmitted with hypotension. Compliance with recommended multidisciplinary assessments within 48 hours included swallowing (88%), mobility (88%), communication (78%), and self care ability (60%). Patients not admitted directly to the stroke unit (19, 38%) were less likely to receive recommended interventions. Compliance with recommended predischarge assessments included suitability of accommodation (100%) and home supports (92%), but only 19% received documented advice about driving.

Management of inpatients with acute stroke in HBH is close to most of the guideline recommendations. The identified deficiencies in patient care are potentially easily rectifiable and full implementation of the guidelines is feasible.