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Comment Authors: Madalena Rosário and Diana Aguiar de Sousa, Department of Neurology, Hospital de Santa Maria, University of Lisbon, Portugal

Original Article: McElwaine P, McCormack J, McCormick M et al. 2017. A comparison of service organisation and guideline compliance between two adjacent European health services.
Available in the Online First section of the European Stroke Journal. doi: 10.1177/2396987317703209

Previous randomized controlled trials have shown that stroke patients cared for in dedicated stroke units have better outcomes than those receiving care elsewhere. The European Stroke Organisation (ESO) has published detailed recommendations for the establishment of such units. However, various factors influence their interpretation and implementation, leading to discrepancies between health services.

In this paper, the authors aimed to compare the stroke services from Northern Ireland (NI) and the Republic of Ireland (ROI) in terms of the resources provided by either, and their concordance with European and UK published recommendations.

The authors used data from the 2015 ROI’s National Stroke Audit and United Kingdom (UK) Sentinel Stroke National Audit Programme. Every hospital reporting over 20 stroke patients was requested to participate and the data collected was then compared with the published guidelines.

78% of ROI hospitals included in this study had stroke units fulfilling ESO recommendations, compared to 100% of NI hospitals. The number of beds available per head of population in NI was 2,5 times that of ROI, with only 1 bed per over 30.000 people in the latter country. Also in ROI, only 54% of stroke patients received care in a stroke unit and, although 24-hour CT imaging was available at all sites, 24-hour physiological monitoring was available only in 54% of units. Considering data from the UK, 96% of patients were cared for in stroke units, 99% sites had 24-h CT imaging and 91% had 24-h physiological monitoring.

In terms of staff, nursing numbers in ROI were significantly higher than in NI, and an opposite tendency was seen regarding care assistants. Most importantly, only 10% of ROI units and none of NI units met the recommended staff ratio for low dependency stroke beds and none of the studied units met the suggested staff ratio for high acuity beds. Nonetheless, inpatient mortality was not significantly different between ROI and the UK.

In conclusion, even though the majority of hospitals in ROI and NI had stroke units according to established criteria, they lacked some important tools and staffing numbers. Also, in ROI, due to the small number of beds available, half of stroke patients were cared for in other hospital departments. This study illustrated the practical difficulties in implementing evidence-based recommendations as well as the need for better resource allocation and bed availability, in order to tackle inequalities in access to stroke care

The original article “A comparison of service organisation and guideline compliance between two adjacent European health services” is available in the Online First section of the European Stroke Journal.

References:

  1. McElwaine P, McCormack J, McCormick M et al. A comparison of service organisation and guideline compliance between two adjacent European health services. European Stroke Journal. 2017;0(0):1-6
  2. Ringelstein EB, Chamorro A, Kaste M et al. European Stroke Organisation recommendations to establish a stroke unit and stroke center. Stroke. 2013;44(3):828-40
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