MANY AREAS HAVE SEEN IMPROVEMENTS AND, ACROSS SCOTLAND, PERFORMANCE HAS RISEN FROM 78 PER CENT TO 84 PER CENT
increased risk of getting back home. These numbers may seem lower than the figures published in last year’s report, but the more difficult to achieve twelve-hour brain scanning standard is now incorporated in reporting of bundle compliance.’
Previous research has suggested that the greater the delay to swallow screen, the higher the risk of stroke-associated pneumonia. Important measures to improve swallow screen performance include early identification of stroke patients and ensuring nurses are trained to undertake a swallow screen promptly recording the result clearly in the admission notes. Against the swallow screen standard, overall Scottish performance improved from 79 per cent to 81 per cent, with particular local improvements in NHS Dumfries and Galloway.
‘The new brain imaging standard of twelve hours has been influential in increasing access to earlier scanning post-stroke,’ the Audit reports. ‘Earlier scanning allows interventions which have been shown to improve outcomes,
such as the use of antiplatelet agents (aspirin and/or clopidogrel).
‘Many areas have seen improvements in performance and, across Scotland, performance has risen from 78 per cent to 84 per cent, however, this still falls short of the 90 per cent target. The final element of the bundle is aspirin initiation by the day after hospital admission, which remains static at 92 per cent.’
The total number of patients receiving thrombolysis across Scotland in 2019 was 980 (10.1 per cent of all stroke admissions), which is similar to previous years (1037 (10.7 per cent) in 2018). However, the Audit showed that there are consistently large variations in the proportion of stroke patients treated between NHS boards – varying from 6.4 per cent in NHS Forth Valley up to 18.1 per cent in NHS Grampian (excluding the small NHS boards where wide variation is expected because of very small numbers of patients).
Whilst higher rates of thrombolysis may not necessarily improve the outcomes for patients, it
does suggest that there may be scope to increase the proportion treated overall. The variation may reflect differences in clinicians’ assessment regarding the balance of benefits and risks for the patients they see. Of course the interval between stroke onset and treatment is the greatest determinant of the likely benefit. Therefore, clinicians who see patients earlier, or who can deliver thrombolysis quicker, with a lower door to needle (DTN) time, are likely to treat a higher proportion of their patients.
Scottish stroke statistics
• 9,751 stroke patients were admitted to Scottish hospitals in 2019
•Stroke Care Bundle compliance was 64 per cent across Scotland: an improvement from 59 per cent in 2018.
• Bundle compliance is measured for the first time incorporating the new twelve-hour brain imaging standard. The Stroke Care Bundle is important because achieving it is associated with a reduced risk of dying and an increased likelihood of getting back home. However, overall compliance remains short of the 80 per cent standard and more work is required to improve performance against this standard.
• The total number of patients who received thrombolysis across Scotland in 2019 was 980 (10.1 per cent of all stroke admissions) which is similar to previous years (1,037 (10.7 per cent) in 2018). However, there were consistently large variations in the proportion of stroke patients treated between NHS boards.
• In 2019, the average door to needle time across Scotland was 52.7 minutes, a decrease from 55.7 minutes in 2018.
EARLIER SCANNING ALLOWS
INTERVENTIONS WHICH HAVE BEEN SHOWN TO IMPROVE OUTCOMES
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