Abstract
Stroke is a leading cause of disability and death in Australia. There is a clear benefit in caring for stroke patients in stroke care units. Access to these centres is limited particularly in the rural setting. Certified stroke care units in the private health care setting are also unheard of. The superiority of these units is thought to be due to better adherence to processes of care (early utility of CT scan, allied health input within 24 hours, neurological observations, DVT prophylaxis and appropriate use of antiplatelet and anticoagulant use). We audited care of 100 patients who presented to the St. John of God Hospital (rural private hospital) over a period of 3 years. This included baseline demographics, adherence of processes of care, utility of appropriate investigations, and outcome measures such as discharge destination, level of function at discharge and complication rates. These data were compared with the national stroke report (AuSCR) and adherence to processes of care was compared with the SCOPE study (the first study to establish the benefit of POC). When compared with data from the AuSCR national report 2012, we found a higher mortality rate, an increased rate of disability on discharge, and a mixed adherence to processes of care. We also found a significant proportion of patients (40%) who were eligible to receive thrombolysis but did not. Overall we found that there were significant strengths to be drawn upon in the rural private healthcare setting and a more organised approach could improve outcomes.
Highlights
Stroke is the leading cause of permanent disability [1] and second most common cause of death in Australia [2]
Lower adherence to key processes of care (POC) in conventional care wards in Australia is thought to be the explanation for poorer outcomes when compared to Stroke care units (SCU) [7]
Our data provides some imposing insights into the outcomes of patients presenting with ischemic stroke and managed in a rural private health care setting
Summary
Stroke is the leading cause of permanent disability [1] and second most common cause of death in Australia [2]. Stroke care units (SCU) have been shown to improve survival and independence when compared with general ward management [3]. Access to this specialised service has been limited by resources. This is the case in the rural setting. This may partially explain the poorer outcomes in stroke treatment seen in the rural setting [4] [5]. Lower adherence to key processes of care (POC) in conventional care wards in Australia is thought to be the explanation for poorer outcomes when compared to SCU [7]. The higher rate of thrombolysis in SCU is thought to be a contributing factor [8]
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