The variation in stroke care: Why?
Dr. Amer Jafar writes:
Stroke can be a devastating disease as it might lead to death in third of the patients and disability in another third. Stroke causes over 4.3 million deaths world-wide annually. The focus on preventing stroke is important in any health care strategy. However; it remains a challenge to meet the standard level of care which is expected for acutely ill patients with ischaemic or haemorrhagic stroke. The recent Royal College of Physicians/London stroke audit1 and the reports in the media yesterday2 regarding stroke care are examples of the variation in the level of care for stroke patients in different regions of the country and even in between different hospitals, trusts or health boards in one area.
The basic standard of stroke care provision includes medical intervention within the first few hours of presentation to the acute medical units in the hospital which should include arranging a CT brain examination within the time window of 0-4.5 hours. Thrombolysing ischaemic stroke patients is vital within this time window. All the recent evidences in medical literature support the notion that the outcome of thrombolysing stroke patients is better than the outcome in otherwise routine conventional medical intervention.
The speed of transferring stroke patients from the general medical assessment units to a specialised stroke unit is another important factor in providing a good standard of care in stroke medicine.
There are different factors which can lead to the variation between different regions in the country with regard of the stroke care.
- Stroke care can be expensive and not every hospital is expected to provide an immediate access to CT scanning or accessing immediately the stroke units for admitting patients. Some hospitals are lacking such units in the first place. This is in fact one of the major factor that can lead to the big variation between developing and developed countries regarding stroke care on the global level.
- The issue of leadership and management is important in stroke care. It is a multidisciplinary care which depends on team work. Leaders are expected to practice to the high standard in the field of health in general and in stroke care in particular.
- Providing an acceptable staffing level of skilful medical and other allied health professionals to stroke units is another important factor in improving the stroke care in any region.