Article Figures & Data
Tables
- Table 1
- Characteristics of the study hospitals and survey respondents. EP - emergency physicians, CMO - chief medical officer.
Hospitals 2017 stroke admissions Hospital bed capacity Survey respondent Teaching hospital 1 212 200 Administrator Teaching hospital 2 100 434 ICU Teaching hospital 3 100 607 Administrator Military hospital 1 400 1500 Neurologist Military hospital 2 100 1679 Administrator Private hospital 1 40 354 ICU Private hospital 2 120 300 Administrator Private hospital 3 62 405 EP Private hospital 4 48 460 Neurologist Private hospital 5 150 300 Neurologist Private hospital 6 52 250 EP Private hospital 7 70 450 Administrator Private hospital 8 80 140 Administrator Private hospital 9 20 131 CMO Private hospital 10 60 165 CMO Private hospital 11 66 430 Administrator Private hospital 12 300 600 Administrator Private hospital 13 40 150 Administrator Referral hospital 1 73 200 Internist Referral hospital 2 100 500 Neurologist Referral hospital 3 100 1200 Neurologist Referral hospital 4 500 330 Neurologist Referral hospital 5 200 300 Administrator Referral hospital 6 100 1500 Neurologist Referral hospital 7 375 1200 Neurologist Referral hospital 8 12 344 Administrator Secondary hospital 1 16 131 Internist Secondary hospital 2 22 120 CMO Secondary hospital 3 20 150 EP Secondary hospital 4 35 100 EP Secondary hospital 5 100 207 Administrator Secondary hospital 6 90 178 Internist Secondary hospital 7 40 150 Administrator Secondary hospital 8 5 164 Administrator Secondary hospital 9 65 100 Administrator Secondary hospital 10 9 100 EP Secondary hospital 11 50 200 EP Total 3932 - Table 2
- Stroke service availability in the study hospitals. ICU, intensive care unit; NICE, National Institute for Health and Care Excellence.
Stroke services evaluated Teaching hospital Military hospital Private hospital Referral hospital Secondary hospital Overall Which ward is a patient with symptoms most likely to be admitted to for the first 72 h? Acute stroke unit, n (%) 0 1 (50) 1 (7.69) 1 (12.50) 0 3 (8.11) Emergency department, n (%) 0 1 (50) 1 (7.69) 0 0 2 (5.41) General medical ward, n (%) 0 0 0 0 2 (18.18) 2 (5.41) ICU, n (%) 2 (66.67) 0 10 (76.92) 3 (37.50) 9 (81.82) 24 (64.86) Medical ward, n (%) 0 0 1 (7.69) 2 (25) 0 3 (8.11) Neurology ward, n (%) 1 (33.33) 0 0 2 (25) 0 3 (8.11) Protocols for rapid triage, n (%) 2 (66.67) 2 (100) 8 (61.54) 7 (87.50) 6 (54.55) 25 (67.57) Arrangements with local ambulances, n (%) 1 (33.33) 0 5 (38.46) 1 (12.50) 6 (54.55) 13 (35.14) Protocols for transfer of stroke patients to other hospitals, n (%) 1 (33.33) 0 4 (30.77) 2 (25) 6 (54.55) 13 (35.14) Clinical management guidelines, n (%) 3 (100) 2 (100) 9 (69.23) 7 (87.50) 6 (54.55) 27 (72.97) Standard treatment guidelines, n (%) 1 (100) 0 3 (100) 0 1 (100) 5 (13.51) World Stroke Society clinical guidelines, n (%) 1 (100) 0 2 (100) 0 0 3 (8.11) NICE clinical guidelines, n (%) 1 (100) 1 (100) 1 (100) 1 (100) 1 (100) 5 (13.51) American Stroke Association guidelines, n (%) 0 1 (100) 4 (100) 2 (100) 0 7 (18.91) On-call stroke team, n (%) 0 2 (100) 4 (30.77) 5 (62.50) 0 11 (29.73) Stroke code, n (%) 0 2 (100) 3 (23.08) 4 (50) 0 9 (24.32) 24-h coverage Emergency consultant, n (%) 2 (66.67) 2 (100) 10 (76.92) 7 (87.50) 2 (18.18) 23 (62.16) Neuroradiologist, n (%) 2 (66.67) 2 (100) 6 (46.15) 7 (87.50) 2 (18.18) 19 (51.35) Neurosurgery consultant, n (%) 3 (100) 2 (100) 13 (100) 7 (87.50) 2 (18.18) 27 (72.97) Neurologist, n (%) 2 (66.67) 2 (100) 13 (100) 8 (100) 1 (9.09) 26 (70.27) Stroke physician, n (%) 1 (33.33) 2 (100) 3 (23.08) 5 (62.50) 1 (9.09) 12 (32.43) ICU consultant, n (%) 3 (100) 2 (100) 13 (100) 6 (100) 2 (18.18) 26 (10.27) Acute stroke assessment scale, n (%) 2 (66.67) 2 (100) 9 (69.23) 7 (87.50) 5 (45.45) 25 (67.57) Dedicated stroke unit, n (%) 0 1 (50) 2 (15.38) 2 (25) 0 5 (13.51) Adequate number of beds Adequate beds, n (%) 0 1 (100) 1 (50) 2 (100) 0 4 (10.81) More than adequate beds, n (%) 0 0 1 (50) 0 0 1 (2.7) Factors accounting for the lack of stroke unit Inadequate clinical staff, n (%) 2 (100) 0 7 (100) 4 (100) 11 (100) 24 (64.68) Financial constraints, n (%) 1 (100) 0 2 (100) 1 (100) 1 (100) 5 (13.51%) Lack of administrative staff, n (%) 1 (100) 1 (100) 2 (100) 0 2 (100) 6 (16.21%) Unaware of stroke unit care, n (%) 0 0 0 0 2 (100) 2 (5.41) Recommended provision of a stroke unit, n (%) 3 (100) 2 (100) 13 (100) 8 (100) 8 (72.73) 34 (91.89) Fibrinolytic therapy, n (%) 2 (66.67) 2 (100) 11 (84.62) 7 (87.50) 5 (45.45) 27 (72.97) Patients received IV Rt-PA, mean ± std. dev. 19±12.72 29.5±13.4 7.09±8.57 15.85±14.75 13±12.58 Inadequate administrative staff, n (%) 0 0 2 (100) 0 0 2 (5.41) Surgical treatment for acute stroke, n (%) 2 (66.67) 2 (100) 11 (84.62) 6 (75) 1 (9.09) 22 (59.46) Carotid angioplasty, n (%) 0 2 (100) 8 (100) 5 (100) 0 15 (40.54) Urgent mechanical thrombectomy, n (%) 1 (100) 2 (100) 5 (100) 5 (100) 0 13 (35.14) Decompressive craniotomy, n (%) 2 (100) 2 (100) 10 (100) 6 (100) 1 (100) 21 (56.76) Discharge care plans, n (%) 2 (66.67) 2 (100) 8 (61.54) 6 (75) 7 (63.64) 25 (67.57) Contact number at discharge, n (%) 1 (33.33) 1 (50) 9 (69.23) 6 (75) 4 (36.36) 21 (56.76) Patient information at admission and discharge Stroke condition, n (%) 1 (100) 1 (100) 7 (100) 4 (100) 4 (100) 17 (45.95) Local community care arrangements, n (%) 0 1 (100) 3 (100) 0 0 4 (10.81) Local voluntary associations, n (%) 0 1 (100) 0 0 0 1 (2.7) Community stroke support groups, n (%) 0 1 (100) 0 1 (100) 0 2 (5.41) Swallow evaluation within 24 hours, n (%) 1 (33.33) 2 (100) 7 (53.85) 7 (87.50) 4 (36.36) 21 (56.76) Screening protocol for swallowing, n (%) 1 (33.33) 2 (100) 6 (46.15) 6 (75) 2 (18.18) 17 (45.95) How many of the following professionals are on the stroke team? Clinical psychologist, (median) 0.0 1.0 1.0 1.0 0.0 Family medicine, (median) 0.0 8.5 1.5 0.0 0.0 Neurologist, (median) 2.0 4.0 2.0 3.5 0.0 Neurosurgeon, (median) 3.0 3.5 2.0 2.5 0.0 Physician specialist, (median) 0.0 0.5 3.0 2.0 2.0 Resident, (median) 1.0 3.5 1.5 2.0 5.0 Stroke care coordinator, (median) 0.0 0.5 0.0 0.0 0.0 Trained stroke nurse, (median) 0.0 0.5 0.0 0.0 0.0 Emergency physician, (median) 3.0 12.5 4.0 7.0 4.0 Occupational therapist, (median) 0.0 3.0 0.0 0.0 0.0 Physiotherapist, (median) 2.0 1.0 5.0 3.0 1.0 Speech pathologist, (median) 0.0 1.5 1.0 2.0 0.0 Social worker, (median) 1.0 1.0 2.0 2.0 1.0 Dietician, (median) 2.0 1.5 2.0 1.0 1.0 Specialist for stroke, n (%) 2 (66.67) 1 (50) 5 (38.46) 6 (75) 3 (27.27) 17 (45.95) Program for professional development, n (%) 0 1 (50) 3 (23.08) 4 (50) 3 (27.27) 11 (29.73) Stroke team involved in quality improvement, n (%) 1 (33.33) 1 (50) 5 (38.46) 5 (62.50) 1 (9.09) 13 (35.14) Health policy support level (national) High support, n (%) 0 0 2 (5.38) 0 0 2 (5.41) Average support, n (%) 2 (66.67) 2 (100) 7 (53.85) 3 (37.50) 2 (18.18) 16 (43.24) Limited support, n (%) 0 0 2 (15.38) 3 (37.50) 5 (45.45) 10 (27.03) Low support, n (%) 0 0 0 0 4 (36.36) 4 (10.81) No support, n (%) 1 (33.33) 0 2 (15.38) 2 (25) 0 5 (13.51) Health policy support level (hospital) High support, n (%) 1 (33.33) 1 (50) 4 (30.77) 2 (25) 0 8 (21.62) Average support, n (%) 1 (33.33) 1 (50) 8 (61.54) 4 (50) 4 (36.36) 18 (48.65) Limited support, n (%) 0 0 1 (7.69) 1 (12.50) 2 (18.18) 4 (10.81) Low support, n (%) 0 0 0 0 4 (36.36) 4 (10.81) No support, n (%) 1 (33.33) 0 0 1 (12.50) 1 (9.09) 3 (8.11) Limitations of the acute stroke services No ward, n (%) 2 (100) 1 (100) 7 (100) 5 (100) 10 (100) 25 (67.57) Inadequate clinical staff, n (%) 1 (100) 1 (100) 6 (100) 4 (100) 9 (100) 21 (56.76) Financial constraints, n (%) 1 (100) 1 (100) 8 (100) 3 (100) 4 (100) 17 (45.95) Health policy support, n (%) 2 (100) 1 (100) 7 (100) 3 (100) 3 (100) 16 (43.24) Lack of political will, n (%) 2 (100) 1 (100) 2 (100) 3 (100) 2 (100) 10 (27.03) Stroke register or database, n (%) 0 2 (100) 2 (15.38) 3 (37.50) 2 (18.18) 9 (24.32) Interventions to promote stroke awareness, n (%) 1 (33.33) 2 (100) 9 (69.23) 5 (62.50) 2 (18.18) 19 (51.35) Rehabilitative programs, n (%) 2 (66.67) 1 (50) 3 (23.08) 2 (25) 0 8 (21.62) - Table 3
- World Stroke Organization checklist. MRA, magnetic resonance angiography; EEG, electroencephalogram; MRI, magnetic resonance imaging; CT, computed tomography.
Component of acute stroke services Teaching hospital Military hospital Private hospital Referral hospital Secondary hospital Overall MRA, n (%) 3 (100) 2 (100) 13 (100) 7 (87.50) 2 (18.18) 27 (72.97) Computed tomographic angiography, n (%) 3 (100) 2 (100) 13 (100) 6 (75) 1 (9.09) 25 (67.57) EEG services availability, n (%) 1 (33.33) 2 (100) 12 (92.31) 7 (87.50) 1 (9.09) 23 (62.16) Echocardiogram services, n (%) 2 (66.67) 2 (100) 13 (100) 8 (100) 5 (45.45) 30 (81.08) Neurovascular ultrasound, n (%) 2 (66.67) 2 (100) 12 (92.31) 8 (100) 5 (45.45) 29 (78.38) MRI, n (%) 3 (100) 2 (100) 13 (100) 8 (100) 6 (54.55) 32 (86.49) CT scanner, n (%) 3 (100) 2 (100) 13 (100) 8 (100) 10 (90.91) 36 (97.30) Arteriovenous malformation treatment, n (%) 1 (100) 2 (100) 6 (100) 5 (100) 0 14 (37.84) Surgery for cerebral aneurysm, n (%) 1 (100) 2 (100) 5 (100) 5 (100) 0 13 (35.14) Carotid endarterectomy, n (%) 1 (100) 2 (100) 4 (100) 5 (100) 0 12 (32.43) Nurses, mean ± std. dev. 2.6±4.61 8.5±10.60 7.1±5.46 9.14±13.65 5.11±3.58 Aspirin provided for eligible patients, n (%) 3 (100) 2 (100) 11 (84.62) 8 (100) 11 (100) 35 (94.59) Effective rehabilitation services, n (%) 2 (66.67) 2 (100) 7 (53.85) 4 (50) 4 (36.36) 19 (51.35)
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