Stroke services have improved but remain overstretched
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《英国医生杂志》
Stroke services in the NHS have improved considerably in recent years, but capacity remains inadequate to meet the needs of all patients, says the National Sentinel Audit of Stroke. The survey has been conducted twice a year since 1998, and this year it included 256 hospitals in England, Wales, Northern Ireland, and the Channel Islands. The exercise is carried out by the Royal College of Physicians of London and is funded by the Healthcare Commission.
Eighty percent of hospitals in England now have stroke units, but the number of beds still needs to double to provide specialist care for all patients, the latest audit report says. In Wales the picture is bleaker, with stroke units in only 45% of hospitals.
Ninety per cent of stroke units now have a physician specialising in stroke, but these doctors are able to provide a median of only three sessions a week. A typical district general hospital would require two full time physicians to provide a stroke service of adequate quality. Nurses, psychologists, and social workers are also in short supply.
"The care that stroke patients receive is still woefully inadequate," said Jon Barrick, chief executive of the Stroke Association. "Stroke is the UK抯 third biggest killer, with over 130 000 people having a stroke every year. Stroke is also the major cause of severe disability in the UK. Therefore it is unacceptable that current standards of care do not reflect the impact of stroke."
Despite an increase in the number of stroke units—driven in England by targets in the national service framework for older people—half inpatients admitted for stroke are still cared for on general wards. Two thirds of hospitals apply selection criteria for admission to stroke units, presumably because they are rationing a limited resource, the audit report says. Hospitals have not expanded to meet demand, and in some cases the units were not large enough to begin with.
The audit also shows shortfalls in acute care. Thirty seven per cent of hospitals with a stroke unit do not provide beds for patients in the acute stage; 56% of units providing acute care do not have access to continuous physiological monitoring (electrocardiography, oximtery, and blood pressure).
Patients also face from service gaps after they leave hospital. Only a quarter of hospitals in England report any form of specialist stroke services in their communities. "The Stroke Association receives calls daily from stroke patients who feel abandoned after they have left hospital," says Mr Barrick. "They need a comprehensive service that supports them at all stages of their condition."
Making better use of existing resources could be the key to increasing capacity, said Professor Ian Philp, the government抯 national director of older people's services in England.
"It's not rocket science, frankly, to work out locally what capacity is going to be needed. It is about organisational will. The challenge is to change organisational culture, systems, and practices."
Professor Philp said that the NHS should aim to exceed existing targets, and he promised to lobby for faster assessment of people with transient ischaemic attacks and for direct referral to acute units for stroke patients.(London Colleen Shannon)
Eighty percent of hospitals in England now have stroke units, but the number of beds still needs to double to provide specialist care for all patients, the latest audit report says. In Wales the picture is bleaker, with stroke units in only 45% of hospitals.
Ninety per cent of stroke units now have a physician specialising in stroke, but these doctors are able to provide a median of only three sessions a week. A typical district general hospital would require two full time physicians to provide a stroke service of adequate quality. Nurses, psychologists, and social workers are also in short supply.
"The care that stroke patients receive is still woefully inadequate," said Jon Barrick, chief executive of the Stroke Association. "Stroke is the UK抯 third biggest killer, with over 130 000 people having a stroke every year. Stroke is also the major cause of severe disability in the UK. Therefore it is unacceptable that current standards of care do not reflect the impact of stroke."
Despite an increase in the number of stroke units—driven in England by targets in the national service framework for older people—half inpatients admitted for stroke are still cared for on general wards. Two thirds of hospitals apply selection criteria for admission to stroke units, presumably because they are rationing a limited resource, the audit report says. Hospitals have not expanded to meet demand, and in some cases the units were not large enough to begin with.
The audit also shows shortfalls in acute care. Thirty seven per cent of hospitals with a stroke unit do not provide beds for patients in the acute stage; 56% of units providing acute care do not have access to continuous physiological monitoring (electrocardiography, oximtery, and blood pressure).
Patients also face from service gaps after they leave hospital. Only a quarter of hospitals in England report any form of specialist stroke services in their communities. "The Stroke Association receives calls daily from stroke patients who feel abandoned after they have left hospital," says Mr Barrick. "They need a comprehensive service that supports them at all stages of their condition."
Making better use of existing resources could be the key to increasing capacity, said Professor Ian Philp, the government抯 national director of older people's services in England.
"It's not rocket science, frankly, to work out locally what capacity is going to be needed. It is about organisational will. The challenge is to change organisational culture, systems, and practices."
Professor Philp said that the NHS should aim to exceed existing targets, and he promised to lobby for faster assessment of people with transient ischaemic attacks and for direct referral to acute units for stroke patients.(London Colleen Shannon)