Standards for the hospital management of stroke patients

To examine the extent to which current guidelines for the hospital management of stroke are being met, a series of 15 specific standards covering initial assessment and management, rehabilitation, discharge and secondary prevention was developed from the guidelines suggested by the King's Fund and the Royal College of Physicians. This article describes these standards, their interobserver agreement on their use in practice. The interobserver agreement on the application of most standards was good (80% or more). A survey of 100 consecutive patients with stroke showed that certain standards were well met (adequate social history, routine investigation, prevention of pressure sores and monitoring of blood pressure), whereas others were poorly met (diagnosis, rapid referral to therapists, functional reassessment, liaison with general practitioners, documentation of multidisciplinary rehabilitation programmes, and communication with patients and relatives). Several standards, especially those central to the rehabilitation process, were met significantly more frequently in patients managed by geriatricians than in those managed by general physicians. This may be attributable to geographical concentration of patients and to rehabilitation led by consultants trained in stroke management. It is suggested that these standards are verifiable measures which can be used more widely to audit the process of care.