Stroke patients admitted to hospital 'out of hours' wait twice as long to be assessed



00:04 GMT, 21 March 2012

About 150,000 Britons have a stroke each year

About 150,000 Britons have a stroke each year

Stroke patients admitted to hospital 'out of hours' wait twice as long to be assessed and suffer delays in getting brain scans and a bed, according to a new report.

The study, covering NHS services in England and Northern Ireland, found 'good evidence' that people admitted on weekends, evenings and bank holidays suffer worse outcomes than those admitted during routine hours.

Researchers found these patients wait twice as long on average to be assessed by a member of a stroke team (typically 188 minutes compared to 87 minutes for those admitted in hours).

The delay in being given a dedicated stroke bed is also longer for patients admitted out of hours (234 minutes compared to 211 minutes) as is the delay to receiving a brain scan (170 minutes compared to 120 minutes).

Accessing prompt care and treatment is essential to reducing the risk of death and disability from stroke, which affects around 150,000 people in the UK each year and kills about 53,000.

The data further showed that patients who suffer a stroke while already in hospital experience the 'worst delays' in being assessed by a member of the stroke team and in getting a scan.

'This suggests that hospital teams need to be educated about stroke symptoms and how to contact the stroke team,' the study said.

Today's report, the Stroke Improvement National Audit Programme (SINAP), covering 32,113 patients, found that one in three (34%) of all stroke victims are admitted to a ward that does not specialise in treating strokes.

This is despite the experts behind the study saying all patients 'need immediate stroke unit care'.

While 94% of patients stay on a stroke bed at some stage during their hospital stay, a significant number do not arrive there quickly enough.

The report said: 'There is no excuse
for units admitting people with acute stroke not to admit them directly
to a specialist bed and commissioners should be urgently reviewing
services where patients do not routinely access stroke units as soon as
possible following admission.'

Overall, there was an improvement in the proportion of patients receiving thrombolysis treatment within 4.5 hours.

Some 8% of patients received the clot-busting treatment following a stroke, up from 1% in the 2008 audit.

Not all patients are eligible for the treatment, which is suitable for those who have suffered acute ischaemic stroke.

Warning signs can include a temporary loss of vision, because a blood clot is passing through the retina

Warning signs can include a temporary loss of vision, because a blood clot is passing through the retina

Today's audit found 7% of all patients were not given the treatment because thrombolysis was not available at the hospital, 5% of patients arrived “outside normal thrombolysis service hours” and 0.3% were not given it because they could not be scanned quickly enough.

Some 46% of patients arrived outside the timeframe when thrombolysis would work, while 12% were not given the drug because of their age.

It found an improvement in the percentage of patients overall who received a brain scan within 24 hours.

In 2006, only 42% of patients were scanned within 24 hours of having symptoms, rising to 59% in 2008 and 70% in 2010.


As well as the classic signs of stroke (such as facial weakness, arm weakness or speech problems), the following could be a sign of a mini stroke.

If you suffer one or more of these, contact a doctor urgently:

Weakness, numbness, clumsiness or pins and needles on one side of the body, or paralysis in an arm or leg.Loss of or blurred vision.Sudden memory loss or confusion.Loss of balance.

Though the symptoms could be due to other conditions, including low blood sugar, migraine or epileptic seizure, the sooner the symptoms are investigated the more likely it is that a doctor will be able to say if it was a mini stroke or not.

Source: The Stroke Association

But the report said: 'The percentage of patients scanned within 24 hours of arrival remains suboptimal and commissioners should consider seriously whether they should be commissioning services in units that can only manage to scan 80% (or fewer) patients within 24 hours of arrival in hospital.'

Overall, 91% of patients are reviewed by a stroke consultant or associate specialist within 72 hours, although this should ideally take place within 24 hours.

'Variation in the percentage of patients seen by a stroke specialist within 24 hours suggests that some services are not providing adequate senior clinical cover, particularly at weekends,' the report said.

The study was commissioned by the Healthcare Quality Improvement Partnership (HQIP) and run by the Royal College of Physicians' (RCP) stroke programme.

Professor Tony Rudd, chairman of the Intercollegiate Stroke Working Party and director of the RCP stroke programme, said: “Acute stroke services are improving in England albeit from a low base.

'Not all hospitals contributed to this national audit and one has to be concerned that the quality of care in the non-participating hospitals may be lagging behind those who have been willing to share their data.

'We will be working hard to increase participation as I believe that publicly available data comparing each hospital against their peers is a very powerful tool to improve the quality of care.'

Health Secretary Andrew Lansley said: 'Care of stroke patients in hospital has improved dramatically over recent years with the majority of patients now treated in specialist stroke units, but, as this audit shows, there is still more to do to improve outcomes from stroke.'