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National audit highlights improvements in stroke care right across Australia

More Australians have access to leading-edge stroke treatment than they did two years ago despite the challenges COVID-19 created within the health system, according to the findings of Stroke Foundation’s 2021 National Stroke Audit.

The Audit is carried out every two years and highlights areas where resources and clinical care meet national quality standards as well as where improvements and changes could be made.

Stroke Foundation Chief Executive Officer Sharon McGowan said the impact of the COVID-19 pandemic across Australia’s health system has been significant and prolonged. It has seen dedicated stroke resources being redistributed across hospital facilities, patients being discharged earlier, and capacity being reduced in some stroke unit services.

“Despite these challenges, health professionals working in stroke have delivered improvements in practice and performance across the board – an outstanding achievement,” Ms McGowan said.

The National Audit identified that 12 Comprehensive Stroke Centres across the country met all 20 recommended elements of acute care including specialist hyperacute treatment 24-hours a day, seven-days a week. This is up from 10 Comprehensive Stroke Centres with that same capability in 2019.

“This is a commendable shift. We all know the pandemic has stretched our hospitals, yet 29 percent of eligible patients still received life-saving stroke treatment over this past year in the best performing services. We need to applaud this and learn from these examples of best-practice right across Australia,” Ms McGowan said.

The optimum time for emergency treatment is within the first “golden hour” of a stroke occurring and can be the difference between someone making a full recovery or being left with a catastrophic lifelong disability.

Ms McGowan said that increasing equity of access to emergency stroke treatment is critical and will enable more Australians to recover and live well after stroke.

“Smaller States and Territories such as Tasmania and Northern Territory do not provide the level of hyperacute care, but are now benefitting from telehealth support which enables them to diagnose stroke quickly and transfer patients interstate to a Comprehensive Stroke Centre. 

“Many people in regional centres also feel the impact of inequitable access. It is both frustrating and heartbreaking to see so many lives being devastatingly impacted in these regions, while people in other parts of the country are afforded a much better chance of survival and recovery.”

“In a country as medically advanced as ours, no-one should be disadvantaged by where they live. We have made huge advances in telehealth over the last two years and must focus on deploying this technology to close the gap between regional and metro access to emergency stroke treatment. Telestroke pathways can ensure all Australians have access to emergency stroke treatment.”

The Audit has also highlighted a gap in the access to care for survivors of stroke after they leave hospital. 

More than 80 per cent of patients who had been in dedicated stroke units left hospital with a comprehensive discharge plan, while of those who did not receive their care in a specialised unit only 62 per cent were discharged with the recovery advice to ensure they live well during their stroke recovery.

Ms McGowan says survivors of stroke have long referred to being released into a ‘black hole’.

“We know that four in 10 stroke survivors will likely experience another stroke, but this can be reduced with better post-discharge care. We need to create a safety net – a specialist navigator service to support survivors, their families and carers to ensure they are aware of and access the care and treatment which will reduce their risk of further strokes. 

Ms McGowan says this can be achieved with the development of Stroke Foundation’s StrokeConnnect Navigator Program.

“Stroke Foundation has successfully tested this navigator service on a smaller scale through programs in the ACT and Tasmania, and we know it makes a significant difference. We are calling on Governments to invest in helping us scale this service to ensure all Australians, regardless of location, can access support to navigate their recovery and to offset that risk of secondary stroke.” 

Stroke costs Australia’s health system $6b per year in direct costs but this would be reduced if more people had access to treatment within the ‘’golden hour’. The Audit found that that only 37 per cent of patients got to hospital fast enough to fit the criteria for clot-busting treatment, which can stop damage to the brain.

“This tells us there is still a lack of understanding that a stroke is a medical emergency, and we promote the F.A.S.T message for this very reason,” Ms McGowan said. 

“The acronym is intended to help people recognise the signs of stroke as a drooping Face, an inability to lift both Arms, and slurred Speech - and the T is for time. You don’t have much time to act, so you must call an ambulance as quickly as you can.”

Ms McGowan said the findings highlight the need for an increased level of education and awareness across Australia, so more people know to act urgently in a stroke emergency. 

Stroke Foundation’s 2021 National Stroke Audit and its key recommendations will now be shared with governments and health services across Australia to improve care delivered to people with stroke. 

Read the full report.