The National Stroke Audit 2021 has revealed improvements in most clinical indicators across the country – even against the backdrop of COVID-19.
Compared to the 2019 Audit, national adherence to Acute Stroke Clinical Care Standard Indicators such as stroke unit care, assessment by a physiotherapist within 24-48 hours of ED arrival, assessment for ongoing rehabilitation, and the development of care plans, have improved incrementally.
The use of a validated stroke screen in the ED improved from 52% to 69% but remains short of the benchmark of 94%.
The Audit showed there was a nationwide decrease in the quality of hyperacute care with thrombolysis within 60 minutes of hospital arrival dropping from 32% in 2019 to 27% in 2021. The benchmark is 66%.
The overall use of thrombolysis in ischaemic stroke has remained unchanged at 11%, compared to 10% in 2019 and 11% in 2017.
The indicators which have the highest levels of adherence in 2021 are use of an antithrombotic on discharge (99%) and lipid-lowering treatment on discharge (92%) for ischaemic stroke.
Use of antihypertensives on discharge for all stroke types sits at 78% against a benchmark of 92%.
Discharge on oral anticoagulants for patients with atrial fibrillation and ischaemic stroke sits at 78% compared to a benchmark of 88%.
The audit, of 3,890 stroke cases and 35,652 acute stroke admission across 115 hospitals, found 37% of patients reach hospital within 4.5 hours.
“Our results indicate not enough Australians are aware that stroke is a time-critical medical emergency,” the Stroke Foundation report said.
The national median time from onset of stroke symptoms to thrombolysis was 2 hours 50 minutes – longer than 2 hours 45 mins in 2019 and 2 hours 36 mins in 2017.
The report, whose co-authors include Associate Professor Monique Kilkenny and Professor Dominique Cadilhac of Monash University, said ongoing efforts to improve care should aim to:
- Increase awareness of the signs of stroke and that stroke is a time-critical medical emergency.
- Improve equity of access to reperfusion therapies especially in regional, rural, and remote areas. Formal policies and pathways across the whole healthcare system are needed to connect dedicated stroke centres to other hospitals via telehealth.
- Improve earlier access to thrombolysis to match international benchmarks.
- Improve access to dedicated stroke unit care and ensure most of the acute care is provided within this unit. Stroke unit teams must have clear medical leadership and a dedicated stroke care coordinator who are actively involved in care.
- Improve holistic patient care including a greater focus on swallow screening, mood assessment and management of incontinence.
- Ensure carers are assessed, trained, and connected to community support prior to patient discharge.
- Ensure all patients are supported through comprehensive discharge processes including a thorough assessment for rehabilitation and a holistic patient-centred discharge care plan.