Weekly Stroke Clinics 'Not Capable' Of Meeting Minimum Standards

Main Category: Stroke
Article Date: 22 Jun 2009 - 2:00 PDT

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Outpatient clinics in District General Hospitals operating on a weekly basis are not able to reach minimum standards for treating patients who have suffered a stroke, according to a new audit published by the Royal College of Physicians. The study, published in Clinical Medicine journal, assessed the timeliness with which an urgent access neurovascular clinic was able to evaluate possible stroke victims between 2000 and 2006. Data showed that the clinic was not able to reach the National Clinical Guideline for Stroke's recommendation that patients who may have suffered a minor stroke or transient ischaemic attack (TIA) receive urgent evaluation within one week.

The study noted that the percentage of patients seen within one week had fallen in the years from 2003 to 2006, and that by 2006, the most common delay from onset of symptoms to being evaluated in the clinic had also risen, to three weeks.

Dr Dennis Briley and team at Stoke Mandeville Hospital asked GPs referring to the clinic to use a proforma to help assess patients as either 'high', 'intermediate' or 'low' risk. They found that on balance high risk patients were seen sooner than those who had been categorised as low or intermediate risk. However, in 2006, the average wait for high risk patients was still 17 days.

Other studies indicate that the highest risk of stoke after a minor stroke or TIA is within the first two weeks. Medical procedures which can prevent death and serious long-term damage to health are most effective when performed quickly after the first stroke. The new National Clinical Guidelines for Stroke recommend implementation of urgent evaluation (within 24 hours of event) of high-risk TIA patients as a key priority. The authors conclude that District General Hospitals need to develop quicker systems to evaluate such patients.

1,292 patients were seen at the clinic over the assessment period with an age range of 18 to 100, with an average age of 67. Stroke was the most common diagnosis (32%), followed by TIA (23%).

Notes

1. The article, An urgent access neurovascular clinic: audit of timeliness, is published in this month's edition of Clinical Medicine journal.

Source
Royal College of Physicians