Stroke care divide costing lives

Inequalities in acute stroke care and services are costing lives and leaving thousands of Australians with unnecessary disability, according to a new Stroke Foundation Report.


Regional Australians were among those most impacted, the report revealed.


The 2017 Acute Stroke Audit, launched at Liverpool Hospital, revealed despite significant advancements in the treatment and care for stroke, patients were still being denied best practice care in Australia.


Stroke Foundation Chief Executive Officer Sharon McGowan said the Audit showed targeted investment and coordination of services was resulting in pockets of improved outcomes, however other services, many of them located in regional areas, were being left behind.


“There is significant opportunity for improvements across the country,’’ Ms McGowan said.


“We know what best practice care looks like with the release of updated Clinical Guidelines for Stroke Management 2017 best practice stroke treatment and care in September, we must now ensure all Australian patients with stroke have access to it.


“The current divide between the haves and have nots in metropolitan and regional areas is extremely concerning, particularly when we know regional Australians are 19 percent more likely to suffer a stroke than their city counterparts.


“Stroke strikes in an instant, attacking the brain – the human control centre. Stroke is a serious medical emergency which requires urgent attention, but with the right treatment at the right time many people are able to recover,’’ she said.


Stroke Foundation Research Advisory Committee Member and leading stroke expert Professor Richard Lindley said the increase in comprehensive stroke centres from one in 2015 to six this year demonstrates what can be achieved.


“Liverpool Hospital demonstrates what can be achieved with a focus on quality stroke services, investment in planning and delivery, as well as patient outcomes,’’ Prof Lindley said.


“As a comprehensive stroke centre the hospital is delivering best practice clot busting treatment (thrombolysis), clot removal treatment (endovascular thrombectomy) and care on a stroke unit 24 hours a day, seven days a week.


“These services save lives and ensure a better quality of life for stroke survivors.


“The travesty is that time-critical stroke treatment and high quality care are not available to all patients.


“Surviving and living well after a stroke should not be determined by your post code. Australia has one of the most advanced trauma systems in the world, we need to apply the same thinking to emergency stroke treatment to ensure people living in regional and rural Australia have the best chance of making a meaningful recovery after a stroke,’’ he said.


Key findings of the Audit included:

  • 36 percent of patients with stroke are reaching hospital within the 4.5 hour window for thrombolysis.
  • Delivery of thrombolysis with appropriate patients has increased to 13 percent, up from 7 percent in 2015.
  • Delivery of thrombolysis within 60 minutes of hospital arrival lags internationally; 30 percent Australia, 59 percent United States of America, 62 percent United Kingdom.
  • 95 stroke units nationally, up from 87 in 2015.
  • 77 percent metropolitan patients with stroke access a stroke unit, compared to 47 percent of regional patients.
  • 66 percent of hospitals with a stroke unit report routine use of clinical guidelines, compared to 28 percent in a hospital without a stroke unit.
  • 35 percent of patients did not have a discharge care (personal recovery) plan, 41 percent did not have a rehabilitation assessment and 30 percent of patients were not provided with risk factor modification advice.


Ms McGowan said the Audit provided a benchmark for clinicians, health administrators and government to improve on.


“This year alone there will more than 56,000 strokes in Australia, that is one stroke every nine minutes,’’ Ms McGowan said.


“The Australian healthcare system must adapt to support healthcare professionals in the provision of best practice stroke care and improve how resources are utilised to deliver the best outcomes for all Australians.


“Stroke is preventable, it can be treated and it can be beaten.


“Government at all levels must come together to address this devastating disease.”  


Audit Report recommendations:

  1. Review stroke service coordination and links, between metropolitan and regional areas, as well as with ambulance services.
  2. Continue to support access to and delivery of time-critical therapy (thrombolysis and endovascular thrombectomy), and ensure all patients in all areas in Australia have a clear access path to be transferred to receive appropriate stroke therapy.
  3. Acute services need to examine bed management and patient flow practices to increase admission rates to a stroke unit and increase length of time treated in a stroke unit.
  4. A greater focus on identifying and addressing patient rehabilitation needs is required.
  5. Review of discharge processes to ensure appropriate risk factor education and medication is delivered.


28 November 2017.