'Significant concern' over stroke service at UHW
One in three stroke patients are not getting appropriate stroke unit care at UHW.
The Waterford News & Star has seen HSE correspondence, which outlines details regarding the current status and future of stroke services at University Hospital Waterford.
It says that the National Clinical Programme for Stroke "views the situation at UHW as a significant concern with one in three stroke patients not getting appropriate care" (stroke unit care).
The information accessed identifies Acute Specialist Stroke Units (ASU) staffed with a stroke specialist multi-disciplinary team as the "single most effective way of delivering improved outcomes for patients presenting to the hospital with a potential stroke".
UHW currently has five dedicated ASU beds with two single side rooms. Current stroke dedicated staffing includes one WTE (whole time equivalent) Stroke Clinical Specialist and one unfilled WTE Speech and Language therapist. The medical, nursing, health and social care professional input is via the UHW complement, which has been in place since before 2011.
UHW underwent a registered audit over a three-month period in 2023 to evaluate the population presenting to the ED "where it was evident that the admitting medical team categorized the patient to a group that would benefit from a direct ASU admission".
Annually this equated to 996 patients.
Also audited was the bed day occupancy (2015 – 2022) of all patients with a confirmed stroke or warning of a stroke (TIA) who were directly admitted to the stroke unit and those admitted to a non-stroke specialist ward (NSSW).
Direct admission to the ASU occurs in 25% of all acute stroke patient presentations and only 6% of transient ischemic attacks (TIAs). National audits (NOCA) confirm that 60% of Stroke admission in UHW at some point in their admission are managed in the ASU. This figure has remained static since the audit was established.
The length of stay on the ASU (acute stroke unit) was significantly shorter than the NSSW (non-stroke specialist ward). Fewer patients admitted directly to the ASU died and more were discharged to the community rather than nursing homes in published data.
Stroke patients admitted to the ASU had an AVLOS (average length of stay) of 13.9 days compared with those admitted to the NSSW of 17.9 bed days.
The correspondence outlines that to exclusively admit confirmed stroke patients and TIA patients directly to an ASU, the number of bed days required annually would be 5,368. In order to safely and effectively treat this cohort of patients, UHW would require infrastructural development and a resourced ASU for a 12 to 14 bed unit.
In response to this information, National Stroke Lead, Ronan Collins said that the National Clinical Programme for Stroke "views the situation at UHW as a significant concern".
The National Clinical Programme for stroke met with the extended stroke multidisciplinary team and the Executive Management team of UHW in June 2023, for what was "a constructive meeting with all parties committed to further improving care for stroke patients at Waterford and the south east region".
The groups jointly identified an immediate need for 12 acute stroke unit beds and a likely longer term need for 24 beds to future proof services.
Mr. Collins outlined, “In 2018 there were 139 acute stroke admissions at UHW compared to 229 last year. The hospital management had undertaken to address the stroke unit bed designation issue and develop a SOP that would serve both the needs of the acute stroke patient and hospital pathways admission.”
The meeting also sought to address staffing gaps and service development and it was advised that funding had been secured by the programme to fill a senior speech and language therapy role on the acute stroke service. A number of strategically identified WTEs were sought, including a number of senior therapy positions to help commence an early supported discharge service for stroke patients and to fill key staffing gaps on the acute stroke service.
None of the stroke programme submissions have been successful.
Mr. Collins said: "We are disappointed naturally, given the published strategy has been adopted by the EMT of the HSE and is in the current programme for government."
