The number of stroke unit beds should be increased so that at least 90% of patients with a stroke are cared for in a stroke unit and the thrombolysis rates in all hospitals providing acute stroke care should also be increased, according to the Irish National Audit of Stroke critical review of national stroke data for Ireland from 2013 to 2021.
The audit, which measured the care for all patients with a stroke in acute hospitals and showed the key trends in acute stroke care from 2013 to 2021, was launched by Professor Joe Harbison, Clinical Lead on the Irish National Audit of Stroke (INAS). He said that their analysis of data from nine years had shown slow but significant areas of improvement in many areas and improved organisation and delivery of care in hospitals even through the challenges of the pandemic.
It was clear however that challenges still existed and key performance indications such as being admitted to a stroke unit (still far off the 90% HSE target), or having swallow assessed on admission, were still not being achieved in too many cases.
The audit recommended that all hospitals providing acute stroke care should have an active stroke governance committee, there should be an increase in the number of early supported discharge teams, the use of the individual health identifier should be expanded to increase follow-up for patients on discharge or transfer to another hospital and a best practice tariff for acute stroke care should be developed.
The report showed that there was an increase in the proportion of patients with a stroke admitted to a stroke unit from 65% in 2013 to 70% in 2021. For patients with a stroke who were admitted to a stroke unit there was an increase in the proportion of their total hospital stay spent in a stroke unit from 57% in 2013 to 68% in 2021.
The IV thrombolysis rate decreased from 11% in 2013 to 10% in 2021 – the target is 12%. The thrombectomy rate has increased from 4.8% in 2016 to 9.5% in 2021. The current thrombectomy rate in Europe is 1.9%.
Stroke is the second leading cause of death in Ireland. There were 34,630 cases recorded between 2013 and 2021. Of these 56% were male (average age 72 years) and 44% were female (average age 78 years).
The number of patients admitted to hospital increased from 4,727 in 2013 to 5,789 in 2021. There was a reduction in the proportion of patients aged 80 years and older and an increase in the proportion of patients aged 64 and younger. The proportion of patients who arrived at hospital within three hours of onset of stroke symptoms decreased from 59% in 2013 to 46% in 2021.
The proportion of patients who saw a doctor within ten minutes increased from 23% in 2016 to 48% in 2021, while the proportion of patients who had a brain scan within one hour increased from 20% in 2013 to 48% in 2021. There was a 29% reduction in mortality for ischaemic stroke.
The median hospital length of stay reduced from 11 days in 2013 to eight days in 2021 and there was an increase in the proportion of patients discharged home with Early Supported Discharge from 2% in 2017 to 10% in 2021.