- 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) |