Abstract
Objectives—To describe the standards of care for stroke patients in England, Wales and Northern Ireland and to determine the power of national audit, coupled with an active dissemination strategy to effect change.
Design—A national audit of organisational structure and retrospective case note audit, repeated within 18 months. Separate postal questionnaires were used to identify the types of change made between the first and second round and to compare the representativeness of the samples.
Setting—157 trusts (64% of eligible trusts in England, Wales, and Northern Ireland) participated in both rounds.
Participants—5589 consecutive patients admitted with stroke between 1 January 1998 and 31 March 1998 (up to 40 per trust) and 5375 patients admitted between 1 August 1999 and 31 October 1999 (up to 40 per trust).
Audit tool—Royal College of Physicians Intercollegiate Working Party stroke audit.
Results—The proportion of patients managed on stroke units rose between the two audits from 19% to 26% with the proportion managed on general wards falling from 60% to 55% and those managed on general rehabilitation wards falling from 14% to 11%. Standards of assessment, rehabilitation, and discharge planning improved equally on stroke units and general wards, but in many aspects remained poor (41% formal cognitive assessment, 46% weighed once during admission, 67% physiotherapy assessment within 72 hours, 24% plan documented for mood disturbance, 36% carers' needs assessed separately).
Conclusions—Nationally conducted audit linked to a comprehensive dissemination programme was effective in stimulating improvements in the quality of care for patients with stroke. More patients are being managed on stroke units and multidisciplinary care is becoming more widespread. There remain, however, many areas where standards of care are low, indicating a need for investment of skills and resources to achieve acceptable levels.
Key Words: stroke; clinical audit
Full Text
The Full Text of this article is available as a PDF (166.4 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bonita R. Epidemiology of stroke. Lancet. 1992 Feb 8;339(8789):342–344. doi: 10.1016/0140-6736(92)91658-u. [DOI] [PubMed] [Google Scholar]
- Gompertz P. H., Irwin P., Morris R., Lowe D., Rutledge Z., Rudd A. G., Pearson M. G. Reliability and validity of the Intercollegiate Stroke Audit Package. J Eval Clin Pract. 2001 Feb;7(1):1–11. doi: 10.1046/j.1365-2753.2001.00274.x. [DOI] [PubMed] [Google Scholar]
- Horner J., Massey E. W., Riski J. E., Lathrop D. L., Chase K. N. Aspiration following stroke: clinical correlates and outcome. Neurology. 1988 Sep;38(9):1359–1362. doi: 10.1212/wnl.38.9.1359. [DOI] [PubMed] [Google Scholar]
- Irwin P., Rudd A. Casemix and process indicators of outcome in stroke. The Royal College of Physicians minimum data set for stroke. J R Coll Physicians Lond. 1998 Sep-Oct;32(5):442–444. [PMC free article] [PubMed] [Google Scholar]
- Langhorne P., Williams B. O., Gilchrist W., Howie K. Do stroke units save lives? Lancet. 1993 Aug 14;342(8868):395–398. doi: 10.1016/0140-6736(93)92813-9. [DOI] [PubMed] [Google Scholar]
- Ottenbacher K. J., Jannell S. The results of clinical trials in stroke rehabilitation research. Arch Neurol. 1993 Jan;50(1):37–44. doi: 10.1001/archneur.1993.00540010033014. [DOI] [PubMed] [Google Scholar]
- Redfern S. Individualised patient care: a framework for guidelines. 1996 Jan 31-Feb 6Nurs Times. 92(5):33–36. [PubMed] [Google Scholar]
- Rudd A. G., Irwin P., Rutledge Z., Lowe D., Wade D., Morris R., Pearson M. G. The national sentinel audit for stroke: a tool for raising standards of care. J R Coll Physicians Lond. 1999 Sep-Oct;33(5):460–464. [PMC free article] [PubMed] [Google Scholar]
- Smithard D. G., O'Neill P. A., Park C., England R., Renwick D. S., Wyatt R., Morris J., Martin D. F., North West Dysphagia Group Can bedside assessment reliably exclude aspiration following acute stroke? Age Ageing. 1998 Mar;27(2):99–106. doi: 10.1093/ageing/27.2.99. [DOI] [PubMed] [Google Scholar]
- Smithard D. G., O'Neill P. A., Parks C., Morris J. Complications and outcome after acute stroke. Does dysphagia matter? Stroke. 1996 Jul;27(7):1200–1204. doi: 10.1161/01.str.27.7.1200. [DOI] [PubMed] [Google Scholar]
- Waters K. R. Getting dressed in the early morning: styles of staff/patient interaction on rehabilitation hospital wards for elderly people. J Adv Nurs. 1994 Feb;19(2):239–248. doi: 10.1111/j.1365-2648.1994.tb01077.x. [DOI] [PubMed] [Google Scholar]
- Wolfe C. D., Tilling K., Beech R., Rudd A. G. Variations in case fatality and dependency from stroke in western and central Europe. The European BIOMED Study of Stroke Care Group. Stroke. 1999 Feb;30(2):350–356. doi: 10.1161/01.str.30.2.350. [DOI] [PubMed] [Google Scholar]