Background: Many countries are developing national audits of stroke care. However, these typically focus on stroke care from acute event to hospital discharge rather than the full spectrum from prevention to long-term care. We report on a comprehensive national audit of stroke care in the community and hospitals in the Republic of Ireland. The findings provide insights into the wider needs of people with stroke and their families, a basis for developing stroke-appropriate health strategies, and a global model for the evaluation of stroke services. Methods: Six national surveys were completed: general practitioners (prevention and primary care), hospital organisational and clinical audit of 2,570 consecutive stroke admissions (acute and hospital care), allied health professionals and public health nurses (discharge to community care), nursing homes (needs of patients discharged to long-term care), and patient and carers (post-hospital phase of rehabilitation and ongoing care). Results: The audit identified substantial deficits in a number of areas including primary prevention, emergency assessment/investigation and treatment in hospital, discharge planning, rehabilitation and ongoing secondary prevention, and communication with patients and families. There was a lack of coordination and communication between the acute and community services, with a dearth of therapy services in both home and nursing home settings. Conclusion: This multi-faceted national stroke audit facilitated multiple perspectives on the continuum of stroke prevention and care. An overall synthesis of surveys supports the development of a multidisciplinary perspective in planning the development of comprehensive stroke services at the national level, and may assist in regional and global development of stroke strategies.

Keywords:
Stroke, Audit, Prevention, Primary care, Stroke units, Rehabilitation, Nursing home
1.
O’Neill D, Horgan F, Hickey A, McGee H: Long term outcome of stroke: stroke is a chronic disease with acute events. BMJ 2008;336:461.
2.
Bonita R, Mendis S, Truelsen T, Bogousslavsky J, Toole J, Yatsu F: The global stroke initiative. Lancet Neurol 2004;3:391–393.
3.
Martin R, Williams C, Maguire C, Coughlan T, Collins DR, O’Neill D: Rehabilitation and stroke research. Ir J Med Sci 2009;178(suppl 8):S327.
4.
Anderson CS, Carter KN, Brownlee WJ, Hackett ML, Broad JB, Bonita R: Very long-term outcome after stroke in Auckland, New Zealand. Stroke 2004;35:1920–1924.
5.
Portelli R, Lowe D, Irwin P, Pearson M, Rudd AG: Institutionalization after stroke. Clin Rehabil 2005;19:97–108.
6.
Horgan F, Crowe M, Keating D, McNamara A, Leahy P: The development of a comprehensive stroke programme in the acute hospital. Ir Med J 1996;89:222.
7.
Collins D, McConaghy D, McMahon A, Howard D, O’Neill D, McCormack PM: An acute stroke service: potential to improve patient outcome without increasing length of stay. Ir Med J 2000;93:84–86.
8.
Crowe M, Delargy M: Hospital services for patients with acute stroke in Ireland: the Volunteer Stroke Scheme survey of consultant opinion. Ir Med J 2000;93:15–16.
9.
Noone I, Fan CW, Tarrant H, O’Keeffe S, McDonnell R, Crowe M: What happens to stroke patients after hospital discharge? Ir Med J 2001;94:151–152.
10.
Coughlan T, O’Neill D: Hemiplegia of the will and trends in stroke incidence. Ir Med J 2004;97:294–295.
11.
Council on Stroke: Towards Excellence in Stroke Care. Dublin, Council on Stroke, Irish Heart Foundation, 2000.
12.
Intercollegiate Working Party for Stroke: Concise Report on the National Sentinel Audit of Stroke 2006. London, Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, 2006.
13.
Howell E, Graham C, Hoffman A, Lowe D, McKevitt C, Reeves R, et al: Comparison of patients’ assessments of the quality of stroke care with audit findings. Qual Saf Health Care 2007;16:450–455.
14.
Horgan F, Hickey A, McGee H, O’Neill D: National Audit of Stroke Care. Dublin, Irish Heart Foundation, 2008.
15.
Whitford DL, Hickey A, Horgan F, O’Sullivan B, McGee H, O’Neill D: Is primary care a neglected piece of the jigsaw in ensuring optimal stroke care? Results of a national study. BMC Fam Pract 2009;10:27.
16.
Cowman S, Royston M, Hickey A, Horgan F, McGee H, O’Neill D: Stroke and Nursing Home care: a national survey of nursing homes. BMC Geriatr 2010;10:4.
17.
Saliba D, Elliott M, Rubenstein LZ, Solomon DH, Young RT, Kamberg CJ, et al: The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community. J Am Geriatr Soc 2001;49:1691–1699.
18.
Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361–370.
19.
Mahoney FI, Barthel DW: Functional Evaluation: the Barthel Index. Md State Med J 1965;14:61–65.
20.
O’Hanlon A, McGee H, Garavan R, Conroy R, Barker M, Winder R, et al: HeSSOP-2: an introduction to longitudinal studies in Ireland – the Health and Social Services for Older People (HeSSOP) study: longitudinal evaluation of older Irish adults. Ir J Med Sci 2007;176(suppl 6):S211.
21.
Simon C, Kumar S: Stroke patients’ carers’ views of formal community support. Br J Community Nurs 2002;7:158–163.
22.
European Stroke Organisation (ESO) Executive Committee, ESO Writing Committee: Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 2008;25:457–507.
23.
Kjellstrom T, Norrving B, Shatchkute A: Helsingborg Declaration 2006 on European stroke strategies. Cerebrovasc Dis 2007;23:231–241.
24.
Balanda P, Barron S, Fahy L: Making Chronic Conditions Count: Hypertension, Stroke, Coronary Heart Disease, Diabetes. Dublin, Institute of Public Health in Ireland, 2010.
25.
Irwin P, Hoffman A, Lowe D, Pearson M, Rudd AG: Improving clinical practice in stroke through audit: results of three rounds of National Stroke Audit. J Eval Clin Pract 2005;11:306–314.
26.
Gross B, Feldman-Idov Y, Molshatzki N, Azrilin O, Goldbourt U, Bornstein NM, Tanne D. Ethnic variations in acute ischemic stroke: findings from the National Acute Stroke Israeli Survey (NASIS). Cerebrovasc Dis 2011;31:506–510.
27.
Béjot Y, Aouba A, de Peretti C, Grimaud O, Aboa-Eboulé C, Chin F, Woimant F, Jougla E, Giroud M: Time trends in hospital-referred stroke and transient ischemic attack: results of a 7-year nationwide survey in France. Cerebrovasc Dis 2010;30:346–354.
© 2011 S. Karger AG, Basel
2011
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.