First Irish National Audit of Stroke Care led by TCD and RCSI

Posted on: 14 April 2008

The results of the first Irish National Audit of Stroke Care (INASC), carried out by a joint research team from Trinity College Dublin and the Royal College of Surgeons in Ireland (RCSI) were published last week. The project commissioned by the Irish Heart Foundation (IHF), in association with the Department of Health and Children, is the largest study of stroke ever to take place in Ireland. The research team was led by Professor of Gerontology, Desmond O’Neill at TCD and AMiNCH in Tallaght and Professor Hannah McGee of the RCSI.

Each year around 10,000 Irish people have a stroke and about 2,500 people die (more than from bowel, breast and prostate cancer combined), yet just one Irish hospital out of 37 has a fully resourced stroke unit.

The project involved six separate surveys: hospital clinical and organisational audits, and community-based surveys of general practitioners, allied healthcare practitioners, patients and carers, and nursing homes.

Early diagnosis and treatment for stroke patients can mean the difference between life and death or mild and severe disability for the rest of their lives. The findings from the National Audit of Stroke Care carried out by the TCD and RCSI research team include the following:

1. Only 5 per cent of patients are admitted to hospital within two hours of stroke onset. After two hours a patient’s chance of recovering with little or no disability is greatly reduced.
2. 12 stroke unit beds nationwide. This figure indicates a ratio of 0.03 beds per stroke patient in Ireland – the UK comparison is 0.82 beds. (For every 33 stroke patients who need a bed in Ireland, there is only one available in Ireland.)
3. 30 per cent of hospitals do not have routine access to CT scanning within 48 hours of stroke.
4. Only 41 per cent of hospitals have access to emergency MR scanning.
5. Provision of thrombolysis – treatment to break up abnormal blood clots – is almost non-existent, just one per cent.
6. Only 16 per cent of Irish hospitals provide access to clinics to reduce risk of full stroke to patients who had suffered a mini stroke (Transient Ischaemic Attack).
7. Only 25 per cent of patients have a formal SLT swallow assessment within the (best practice) recommended 72 hours of admission.
8. Only 43 per cent of patients are assessed by a physiotherapist within 72 hours of admission.
9. Just 22 per cent are assessed by an occupational therapist within seven days of admission.
10. Carers receive little or no information on what to expect when a patient returns home.
11. One in 10 carers could be classified as at risk of health problems themselves
12. Access to rehabilitation for young patients is limited – only five hospitals accept stroke patients under the age of 65 years to a rehabilitation unit.