Evolution of a model for the thrombolysis of acute stroke patients

Abstract

The National Audit Office (NAO, 2005) has reported that the priority afforded to stroke care should be increased, given its impact on health and cost to the NHS. It recommends improvements in preventing, treating and managing stroke patients in line with recent evidence. Thrombolysis for acute ischaemic stroke is a proven treatment that produces good results in significant numbers of patients (Mar et al, 2005). However, owing to various barriers, many hospitals in the UK have failed to implement effective systems to facilitate the delivery of this treatment to acute stroke patients. These barriers include a lack of skill, nursing knowledge, and 'fast-track' organization relating to thrombolysis as a treatment for acute stroke. Fears of intracranial bleeding and lack of appropriate stroke unit beds and issues of consent have also been identified as further problems (Innes and International Stroke Trial (IST-3), 2003). Taking these concerns into consideration, Scarborough District General Hospital has developed a multidisciplinary model with the Coronary Care Unit (CCU), integral to the delivery of treatment. Between 2003 and 2005, 24 stroke patients have received thrombolysis treatment and have been cared for in CCU. Outcome results have been positive, with 51% of patients demonstrating a significant benefit at 7 days post-stroke. This model has broken traditional professional and speciality boundaries to allow patients to receive treatments they otherwise would not have received. Moreover, it provides the potential for further exploration into the wider implementation of thrombolysis for acute stroke patients in the UK.