Watchdog finds that NHS is failing stroke patients
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《英国医生杂志》
The UK National Audit Office has found that the NHS is failing stroke patients at all points of the patient's journey from initial emergency treatment through to rehabilitation.
The study found that stroke costs the economy ￡7bn ($12.1bn; 10.4bn) a year, making it the most expensive illness in the United Kingdom. But by failing to prioritise stroke cases as medical emergencies the NHS was missing out on savings that would result from shorter hospital stays and higher recovery rates, the watchdog found.
The study found that emergency care was lacking throughout the health service—despite the fact that rapid access to specialised services reduces death and disability in stroke patients. Although patients with a suspected stroke should have a brain scan within three hours, most patients in 2004 waited more than two days. Most hospitals have the capacity to provide computed tomography scans within 24 hours of admission, the report says.
Thrombolytic drugs can improve a patient's chance of recovery after a stroke but are "rarely" part of acute stroke care in England. If England could achieve the same rate of thrombolysis as leading Australian hospitals—9% of patients rather than 2%—it could save the health service ￡16m a year, with more than 1500 patients recovering from strokes who would not have done so, the report says.
The report says that the clinically accepted "gold standard" for treatment of stroke patients is in a specialised stroke unit. However, last year only 41% of patients were admitted to a stroke unit. A target for all hospitals to have stroke units by 2004 has still not been achieved, and the watchdog had anecdotal evidence that some units were actually closing to save money. If access was increased to 75% of patients, 550 deaths could be prevented.
In the best areas, such as Newcastle upon Tyne, ambulance trusts, emergency departments, radiology departments, and stroke teams provided an integrated emergency response to stroke cases.
Only half of stroke patients received the rehabilitation services they needed in the first six months after discharge, the study found.
The National Audit Office has urged the Department of Health to put a higher priority on stroke care. It said that coronary heart disease and cancer had been given far more attention. As a result deaths from heart disease were falling at a sharper rate than those from stroke. It added that public awareness of the risk factors for a stroke was low and should be subject to high profile campaigning. About 111 000 strokes and a further 20 000 transient ischaemic attacks ("mini-strokes") occur in England every year.
The health department acknowledged that "there is more to be done" on stroke and announced a programme to expand the number of trainee doctors specialising in stroke. Currently there are six such trainees, compared with 430 in coronary heart disease.
The Stroke Association said the report provided "the strongest of arguments for urgent action to be taken now."
"The report demonstrates that the faster the diagnosis the higher the quality of care and rehabilitation that stroke patients receive, the better will be the outcome," said the association's chief executive, Jon Barrick.(Rebecca Coombes)
The study found that stroke costs the economy ￡7bn ($12.1bn; 10.4bn) a year, making it the most expensive illness in the United Kingdom. But by failing to prioritise stroke cases as medical emergencies the NHS was missing out on savings that would result from shorter hospital stays and higher recovery rates, the watchdog found.
The study found that emergency care was lacking throughout the health service—despite the fact that rapid access to specialised services reduces death and disability in stroke patients. Although patients with a suspected stroke should have a brain scan within three hours, most patients in 2004 waited more than two days. Most hospitals have the capacity to provide computed tomography scans within 24 hours of admission, the report says.
Thrombolytic drugs can improve a patient's chance of recovery after a stroke but are "rarely" part of acute stroke care in England. If England could achieve the same rate of thrombolysis as leading Australian hospitals—9% of patients rather than 2%—it could save the health service ￡16m a year, with more than 1500 patients recovering from strokes who would not have done so, the report says.
The report says that the clinically accepted "gold standard" for treatment of stroke patients is in a specialised stroke unit. However, last year only 41% of patients were admitted to a stroke unit. A target for all hospitals to have stroke units by 2004 has still not been achieved, and the watchdog had anecdotal evidence that some units were actually closing to save money. If access was increased to 75% of patients, 550 deaths could be prevented.
In the best areas, such as Newcastle upon Tyne, ambulance trusts, emergency departments, radiology departments, and stroke teams provided an integrated emergency response to stroke cases.
Only half of stroke patients received the rehabilitation services they needed in the first six months after discharge, the study found.
The National Audit Office has urged the Department of Health to put a higher priority on stroke care. It said that coronary heart disease and cancer had been given far more attention. As a result deaths from heart disease were falling at a sharper rate than those from stroke. It added that public awareness of the risk factors for a stroke was low and should be subject to high profile campaigning. About 111 000 strokes and a further 20 000 transient ischaemic attacks ("mini-strokes") occur in England every year.
The health department acknowledged that "there is more to be done" on stroke and announced a programme to expand the number of trainee doctors specialising in stroke. Currently there are six such trainees, compared with 430 in coronary heart disease.
The Stroke Association said the report provided "the strongest of arguments for urgent action to be taken now."
"The report demonstrates that the faster the diagnosis the higher the quality of care and rehabilitation that stroke patients receive, the better will be the outcome," said the association's chief executive, Jon Barrick.(Rebecca Coombes)