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ABSTRACT
AIM: To audit the current delivery of stroke care, including post-discharge community rehabilitation, in a consecutive group of acute stroke patients admitted to North Shore Hospital (NSH), Waitemata District Health Board.
METHODS: A retrospective audit from 1 January 2014 to 28 February 2014 conducted at North Shore Hospital.
RESULTS: The clinical care of 72 patients was reviewed. Longer delays for initial key multidisciplinary stroke assessments are seen in this audit compared to the Royal College of Physicians, Sentinel Stroke National Audit Programme (RCP SSNAP 2013). Results for therapy intensity for physiotherapy compare less favourably with the RCP SSNAP. Prescription rates for oral anticoagulation for atrial fibrillation (AF) at final discharge from hospital is lower in this audit in comparison to the RCP SSNAP audit (54%, 95% CI=33%-73% vs 75.6%). Results for mortality rate and rate for new institutionalisation on discharge are comparable to the RCP SSNAP (11%, 95% CI=5%-20% vs 14.8% and 7%, 95% CI=2%-15% vs 8% respectively). The median number of days to community physiotherapy and occupational therapy follow up were 29 days and 25 days respectively.
CONCLUSION: Key areas for improvement in stroke care identified in this audit are anticoagulation for stroke prevention in AF, time to key multidisciplinary stroke assessments and access to community rehabilitation.
Stroke is a major health problem in New Zealand. It is the second leading cause of health loss in older adults aged 75 years and above, after coronary heart disease.1 Since 1980, mortality rates from cerebrovascular disease have declined, reflecting improvements made in stroke care in the last few decades.2 Although the incidence of cerebrovascular disease is also declining, it is projected that the burden from stroke will rise in the future as a consequence of the ageing population.3
Methods
This is a retrospective audit from 1 January 2014 to 28 February 2014 conducted at North Shore Hospital (NSH). Cases were identified using the NSH Stroke Registry, an inpatient prospective record of all stroke referrals received by the Stroke Service, and a search through the hospital discharge summary database.
The types of stroke included in the study were ischaemic strokes and spontaneous intracerebral haemorrhage. Transient ischemic attacks (TIAs), subarachnoid haemorrhage, subdural or extradural haemorrhage, haemorrhage into a cerebral tumour or post-traumatic intracerebral haemorrhage were excluded...