A large proportion of eligible NHS hospital trusts seem to be meeting the UK government target for setting up stroke units, but in name only, suggests a national audit, published in Quality and Safety in Health Care.

And only just over one in three stroke patients admitted to hospital actually spends any time on a specialist stroke unit, the audit shows.

The findings are based on returns on inpatient stroke care to the National Sentinel Audit of Stroke for 2001-2. In all, 240 hospitals in England, Wales and Northern Ireland, covering more than 8,000 stroke patients, took part, accounting for 95% of those eligible.

The results showed that almost three out of four hospitals had a stroke unit, in compliance with the government target for every hospital treating stroke patients to have a specialist unit by April 2004. This goal was set out in the policy document, the National Service Framework for Older People.

However, no additional funds were set aside to develop these services, say the authors.

Only just over one in three (36%) stroke patients admitted to hospital actually spent any time on a stroke unit, the audit revealed.

There is as yet no widely accepted definition of a stroke unit, say the authors, but research has identified some key organisational features that reduce death and disability among stroke patients.

These include coordinated multidisciplinary rehabilitation; staff with a specialist interest in stroke or rehabilitation; routine involvement of carers in the rehabilitation process; regular programmes of education and training; and information provided to patients and carers.

But fewer than half (46%) the units claimed to have all five key features; and 28% had three or fewer. Almost one in five (18%) did not hold weekly multidisciplinary meetings, and of those that did, a similar proportion were not attended by physiotherapists, occupational therapists, nurses, or senior doctors.

Staffing levels and available skills also varied widely within the units, and the quality of care provided in some specialist stroke units often failed to meet basic standards.

A "significant number" had no dietician or social worker, and nearly one in five had no speech and language therapy. Three out of five had no clinical psychology.

The authors conclude: "This study suggests that in many hospitals [the target] is being achieved without adequate resource or expertise."

[Stroke units: research and reality. Results from the National Sentinel Audit of Stroke Qual Saf Health Care 2005; 14: 7-12]
[When is a stroke unit not a stroke unit? (commentary) Qual Saf Health Care 2005; 14: 6]

Dr Anthony Rudd, Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, London, UK
Tel: +44 (0)20 7188 2515; +44 (0)7751 310 953
Email: Anthony.ruddkcl.ac

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