Acute stroke unit improves stroke management-four years on from INASC

Area of Science:

• Neurology
• Public Health
• Healthcare Management

Background:

• The 2008 Irish National Audit of Stroke Care (INASC) revealed suboptimal stroke management practices compared to UK audits.
• Following INASC, University Hospital Limerick established an acute stroke unit and a dedicated stroke database.

Purpose of the Study:

• To evaluate improvements in stroke care management at University Hospital Limerick.
• To compare current stroke care indicators against baseline data from the 2008 INASC.

Main Methods:

• A retrospective audit of 89 stroke patient admissions.
• Comparison of 12 key stroke management indicators with INASC 2008 data.
• Statistical analysis to determine significant improvements (p-values provided).

Main Results:

• Significant improvements observed in 8 of 12 key indicators compared to INASC.
• Brain scan within 24hrs increased from 40% to 92.5% (p < 0.001).
• Ischaemic stroke patients receiving anti-thrombotics rose from 85% to 100% (p = 0.001).
• Stroke unit treatment increased from 2% to 55% (p = 0.0000).
• Multidisciplinary team (MDT) agreement on rehab goals rose from 22% to 94% (p = 0.0000).
• Physiotherapy (87% vs 43%) and Speech and Language Therapy (SALT) (74% vs 26%) input significantly improved (p < 0.02).

Conclusions:

• Stroke management at University Hospital Limerick has markedly improved since 2008.
• Implementation of an acute stroke unit and adherence to key indicators have driven positive changes.
• Despite progress, areas for further improvement in stroke care persist.