A radical shake-up of stroke services in England, Wales, and Northern Ireland is urged in a new report, which found that patients admitted at weekends are less likely to have an immediate brain scan or be admitted to a specialist unit.
Urgent action is also needed to tackle ageism in access to stroke services, say the authors of the report, published by the Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians (London) (Age and Ageing advance access, doi: 10.1093/ageing/afm007).
“Overall, the standards of care for stroke patients of all ages are often far from ideal,” they say. “The demonstration that admission at weekends reduces the chances of brain scanning within 24 hours reinforces the need to develop a health service that operates on a seven-day week rather than the current five-day week.
“Scanners often lie idle at night and weekends while patients suffer from a failure to establish an accurate diagnosis. Rehabilitation is rarely provided, except for emergency problems, at weekends. A radical change in working practices is needed to deliver specialist care at all times.''
The study aimed to determine whether access to high quality stroke care is affected by the age or sex of the patient or by weekend admission. The researchers analysed data collected as part of the National Sentinel Audit of Stroke in 2004, which included information on 8718 patients from 246 hospitals in England, Wales, and Northern Ireland.
The results show that older patients are less likely to be treated in a stroke unit than younger patients (risk ratio comparing those aged ≥85 years with those aged <65 years, 0.82; 95% confidence interval 0.75 to 0.90).
Scanning within 24 hours of stroke was done in 71% of patients aged <65 years but in only 51% of those aged ≥85 years. Older patients were also less likely than younger ones to receive secondary prevention, and standards were consistently better for patients of all ages managed in stroke units compared with general wards.
All patients were less likely to be admitted directly to a stroke unit at weekends than during the week (risk ratio 0.77; 0.69 to 0.86). There was little evidence of differences in standards of care between men and women.
The authors say: “These data do confirm that the health service is ill-equipped to provide high-quality emergency stroke care at weekends. Stroke presents at any time and there is no justification to provide high-quality care only during ‘normal' working hours.
“We have shown the related consequences of a stroke at weekends, as it is less likely that the essential investigations will be completed inside the times recommended within the National Clinical Guidelines for Stroke.”
They add, “Regulatory bodies monitoring the quality of healthcare systems should identify ageism as a key target for urgent attention and where necessary apply sanctions to organisations that persistently offend.”
