Only half of stroke services have adequate number of nurses and consultants
Stroke patients are missing out on the best possible care due to a shortage of consultants and nurses, including on weekends, two reports have concluded.
Experts from the Sentinel Stroke National Audit Programme (SSNAP) warned that only half of stroke services have an adequate number of nurses on their stroke units.
As a minimum, there should be 2.375 higher grade nurses for every 10 stroke beds – but only 51% of sites currently meet this target.
On weekends, only 20% of sites have the right number of nurses for the most acutely ill stroke patients and those receiving continuing care. On weekends, there should be at least three registered nurses on duty per 10 stroke beds. Having fewer nurses is linked to more patient deaths.
Experts from SSNAP, which covers stroke care provided to patients in England, Wales and Northern Ireland, said staffing levels were a “concern”, adding: “Senior nurses are essential not only for ward management, but also for taking overall charge of the ward, maintaining standards of care and ensuring more junior staff are appropriately trained in the management of acute stroke.
“Current nurse staffing levels are insufficient to provide good care for everyone who needs it, and as we implement guidelines, more skilled nurses will be required rather than less.”
There were also problems with recruiting consultants, with 40% of stroke services having an unfilled stroke consultant post – up from 26% in 2014.
Some 28% of services did not meet the standard for having at least one ward round by a consultant per day seven days a week.
While stroke treatment – such as access to clot-busting drugs (thrombolysis) – has improved in recent years, the reports said there were some areas that still need attention.
Thrombectomy – where surgeons use tiny tools to break a blood clot into pieces that can be sucked out of the blood vessel – is only available in a limited number of units and only on weekdays.
There have also been improvements to caring for people suffering a transient ischaemic attack (TIA) or “mini stroke”, but only half of sites can offer a seven-day service to high-risk patients.
TIAs are worrying because they can lead to full blown strokes if not treated promptly. During a TIA, the patient may suffer some short-lived symptoms of a stroke, such as slurred speech or numbness in the face, arms or legs.
The new reports also found that only 6% of sites have speech and language therapists working seven days a week.
And more than a quarter (28%) of patients did not receive a swallowing test within four hours despite needing one.
But they pointed to a range of improvements, including that 47.5% of people now receive a brain scan within an hour of arriving in hospital, compared to 41.9% in 2014. More than 90% are scanned within 12 hours of arrival.
Professor Pippa Tyrrell, associate director for stroke for the Royal College of Physicians Clinical Quality Improvement Department, said: “Stroke care has improved beyond recognition in the last 20 years.
“Patients are almost routinely being admitted to specialist stroke units where, in general, they receive high quality care, they stay in hospital for a very much shorter period of time, and are often discharged to early supported discharge services where rehabilitation continues at home.
“Thirty day mortality has dropped significantly, and people leave hospital with less disability than they did in the past. However, we still have marked variation of services and patient outcomes across the UK.
“Some patients cannot access acute stroke units rapidly, and are therefore denied treatment such as thrombolysis or thrombectomy. Seven-day working is improving, but access to speech and language therapy at weekends remains extremely low.”
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