Report reveals concerns about stroke patient care

9:47am Wednesday 6th January 2010

By James Connell

STROKE patient care at Worcestershire Royal Hospital is below average in some key areas, according to an independent report.

The audit of patient case shows a below average proportion of stroke patients at the Worcester hospital received checks to make sure they were fed properly and given occupational therapy to help them do everyday tasks after suffering the devastating brain attack.

The Sentinel Audit report, carried out in 2008 and 2009 and produced by the Royal College of Physicians, was published in the board papers of the Worcestershire Acute Hospitals NHS Trust board, which met in Worcester last month.

The report showed only four per cent of stroke patients were weighed once during admission, well below the national average of 72 per cent.

Patients are weighed to monitor their nutritional status. Strokes can affect swallowing and the ability of patients to feed themselves.

However, bosses at Worcestershire Acute Hospitals NHS Trust said improvements in this area had taken place in the area of tube feeding in particular since the report was published.

Only 15 per cent of patients at Worcestershire Royal Hospital received occupational therapy (OT) within four days of admission, well below the national average of 66 per cent.

OT helps patients re-learn everyday life skills such as washing and dressing so they can remain more independent.

However, the trust’s medical director Dr Charles Ashton said: “I think I can safely say that every patient who required it would have had an OT assessment.”

Only 41 per cent of patients had anti-platelet drugs (which helps to thin the blood) within 48 hours of admission, well below the national average of 85 per cent.

The drugs make the blood less likely to clot but are largely used to prevent strokes either in the first place (primary prevention) or recurrent strokes (secondary prevention).

At least 60 per cent of stroke patients should spend 90 per cent of their time in a dedicated stroke unit where they enjoy the best chance of recovery.

So far this financial year the trust has achieved this in just 35.56 per cent of the time although the figure rose to 52.86 per cent in October, the latest figure available.

Only four per cent of stroke patients had a swallow assessment to see whether they could swallow properly, well below the national average of 72 per cent.

However, bosses hope to invest £125,000 in speech therapists who may take up positions with Worcestershire Acute Hospitals NHS Trust as early as this spring.

Dr Ashton said: “Whilst there is clearly still a lot of work to be done to improve stroke services it is important to recognise the work already done and the benefit of stroke moving from the shadows into the forefront of the national health agenda.

“I am confident that we will continue to improve services for the benefit of this particular group of patients.”

Dr Ashton said work was also under way to try to move towards a 365 days a year, 24-hour brain scanning.

The scans need to be performed to establish whether it is safe to administer thrombolysis – clot busting drugs – to help a stroke patient but there is a shortage of radiologist and stroke physicians to carry out the work.

Dr Ashton said: “The radiographers (people who operate the scanners) are on call from home.

“In order to achieve the timing necessary for thrombolysis they would have to be resident in the hospital and hence we would have to increase numbers considerably.

“The radiologists likewise perform an on-call service and in order to provide out-of-hours thrombolysis we would need to improve the availability of radiologists (the people who look at the scans).

“The plan would be to employ up to five extra radiologists to provide better cover and a routine evening and weekend service.”

AMBULANCE crews need to test more patients to assess whether they have had a stroke, health chiefs say.

About 75 per cent of patients are now being given the FAST test by ambulance crews, which is designed to ascertain whether someone has suffered the brain attack. The issue was discussed at a meeting of the West Midlands Service Ambulance Service NHS Trust at Sixways Stadium in Worcester last month.

Ambulance crews are supposed to carry out the test on all people with stroke symptoms or who may have suffered a transient ischaemic attack (when complete recovery happens within 24 hours). A stroke is a sudden loss of brain function caused by a blockage or a rupture of a blood vessel to the brain and can be caused by bleeding or clots.

FAST stands for: ● Facial weakness (drooping mouth or eye) ● Arm weakness (inability to raise both arms) ● Speech problems (can the person speak clearly and understand what you say?) ● Time to call 999, if any of these symptoms are displayed. Dr Roger Cooke, the trust’s medical director, said: “We have shown dramatic improvement in the FAST test from 56 per cent up to 75 per cent for September (latest available figure).

“We have addressed the issue very positively and strongly. I don’t think we should underestimate that achievement although nationally we have a little way to go. We have already seen an increased number of strokes being reported because of the publicity. That might apply more pressure to the system.”