Improving stroke care in England, Wales and Northern Ireland. Results from the National Sentinel Audits of Stroke 2010

Introduction: There have been seven rounds of the National Sentinel Stroke audit between 1998 and 2010. The audit is voluntary but since 2004 has seen 100% participation of all eligible NHS Trusts in England, Wales and Northern Ireland. The audit has monitored quality in stroke care provided in terms of both organisation of stroke services and clinical process and outcomes.
Method: Self-reported data from all eligible hospitals was collected using a web tool. For the clinical audit this was done by retrospective case note review by the site.
Results: In 2010 98.5% of NHS Trusts in England, Wales and Northern Ireland provided stroke unit care. This has increased from 79% in 2004. Furthermore, the proportion of stroke patients accessing stroke unit care has increased from 45% to 88% over the same period. This has seen a reduction of 30 day mortality in the audit from 24% to 17% between 2004 and 2010 and a reduction in median length of hospital stay for stroke patients discharged alive from 18 days in 2004 to 10 days in 2010. The rate of patients newly institutionalised at discharge has also decreased from 13 to 10%. Thrombolysis is now available in 74% of hospitals and 5% of all (11,353) stroke patients in the 2010 audit received this treatment.
Conclusion: The National Sentinel Audit of Stroke has demonstrated an unprecedented improvement in NHS stroke care. Stroke care in England, Wales and Northern Ireland now compares favourably with many other countries in Europe and North America.