Quality standard

Quality statement 1: Prompt admission to specialist acute stroke units

Quality statement 1: Prompt admission to specialist acute stroke units

Quality statement

Adults presenting at an accident and emergency (A&E) department with suspected stroke are admitted to a specialist acute stroke unit within 4 hours of arrival. [2010, updated 2016]

Rationale

Specialist acute stroke units are associated with improved patient safety due to better outcomes, such as reduced disability and mortality, because of the range of specialist treatments they provide. Admission to these units should be within 4 hours of arrival at A&E, so that treatment can begin as quickly as possible, and to help prevent complications. Some adults with acute stroke may need treatment in higher-level units, such as high dependency or intensive care units.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements and written clinical protocols to ensure that adults presenting at an A&E department with suspected stroke are admitted to a specialist acute stroke unit within 4 hours of arrival.

Data source: Data can be collected from information recorded locally by healthcare provider organisations, for example, from clinical or service protocols.

Process

Proportion of A&E department presentations of suspected stroke in adults in which the person is admitted to a specialist acute stroke unit within 4 hours of arrival.

Numerator – the number in the denominator in which the person is admitted to a specialist acute stroke unit within 4 hours of arrival.

Denominator – the number of A&E department presentations of suspected stroke.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records. The Sentinel Stroke National Audit Programme (SSNAP) clinical audit and the NHS Digital Clinical Commissioning Group (CCG) Outcomes Indicator Set indicator 3.5 include the percentage of patients directly admitted to a stroke unit within 4 hours of arrival at hospital.

Outcome

a) Mortality rates of adults who have a stroke.

Data source: Data can be collected locally using the SSNAP clinical audit and the NHS Digital CCG Outcomes Indicator Set indicator 1.5 to report mortality within 30 days of hospital admission for stroke.

b) Change in Modified Rankin Score at 6 months after a stroke.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records. The SSNAP clinical audit includes the Modified Rankin Score at 6 months after a stroke.

What the quality statement means for different audiences

Service providers (such as secondary care providers) ensure that systems are in place for adults presenting at an A&E department with suspected stroke to be admitted to a specialist acute stroke unit within 4 hours of arrival.

Healthcare professionals admit adults presenting at an A&E department with suspected stroke to a specialist acute stroke unit within 4 hours of arrival.

Commissioners ensure that they commission services that can demonstrate that adults presenting at A&E departments with suspected stroke are admitted to a specialist acute stroke unit within 4 hours of arrival.

Adults with suspected stroke who go to A&E are admitted to an acute stroke unit within 4 hours of arriving at A&E. An acute stroke unit has special equipment and a team of doctors, nurses, physiotherapists and other healthcare professionals who provide specialist treatment as quickly as possible and help to prevent further problems.

Source guidance

Definitions of terms used in this quality statement

Admission to a specialist acute stroke unit

Admission should be within 4 hours of arrival at the A&E department for adults with suspected stroke, following an initial assessment (unless their care needs should be provided elsewhere, such as an intensive care unit). [Adapted from NICE's guideline on stroke and transient ischaemic attack in over 16s, recommendation 1.3.1, and SSNAP]

Specialist acute stroke unit

A discrete area in the hospital designated for people with stroke. It is staffed by a specialist stroke multidisciplinary team, who have access to equipment for monitoring and rehabilitation. The Stroke Unit Trialists' Collaboration provides 5 key characteristics of markers of a good specialist acute stroke unit:

  • a consultant physician with responsibility for stroke

  • formal links with patient and carer organisations

  • multidisciplinary meetings at least weekly to plan patient care

  • provision of information to patients about stroke

  • funding for external courses and uptake.

[Adapted from NICE's guideline on stroke and transient ischaemic attack in over 16s, recommendation 1.3.1, and SSNAP]