New Zealand National Acute Stroke Services Audit: acute stroke care delivery in New Zealand

AIMS: To audit the care of a consecutive group of acute stroke patients admitted to all District Health Boards (DHBs) in New Zealand. METHODS: A clinical audit involving a review of up to 40 consecutive stroke patients treated and discharged from each DHB between 1st of June 2008 and 31st of December 2008. RESULTS: The clinical care of 832 patients [400 men; median age 77 (interquartile range 67-84) years] admitted to 20 of 21 DHBs was audited. This represents approximately 20% of all stroke patients admitted to hospital in New Zealand over this 6 month period. Most of the audited patients were independent (66%, mRS=2) and 90% lived at home prior to their strokes. At stroke onset, 40% had a known diagnosis of atrial fibrillation (AF), of whom only 24% were taking anticoagulants. Thirty-eight percent of patients arrived in hospital within 4.5 hours of stroke onset but only 3% were treated with stroke thrombolysis. Only 28% of patients were managed in a stroke unit but these patients had higher rates of thrombolysis, more rapid access to multidisciplinary team assessments and a lower rate of stroke progression (8% vs 15%, p<0.01). Only 21% of ischaemic stroke patients received aspirin within 48 hours and 35% of patients had a speech-language therapist assessment within 48 hours of admission. CONCLUSION: Access to stroke unit care and thrombolysis rates remain low in New Zealand and should be seen as the top priorities for acute stroke care improvement along with anticoagulation for stroke prevention in AF, acute aspirin use and increased speech language therapy assessments.