Editorial: Stroke services at University Hospital Waterford grossly under-resourced

Correspondence seen by the Waterford News & Star indicates gross under-resourcing of the Acute Specialist Stroke Unit at University Hospital Waterford.

The information contained in the correspondence reveals that one in three stroke patients are not getting the appropriate level of care at admission in Waterford's Model 4 hospital. 

This runs contrary to the published strategy for stroke care included in the current Programme for Government. 

It is also despite submissions by the National Clinical Programme for Stroke, led by National Stroke Lead, Ronan Collins, for improved resources at UHW. 

Submissions in 2022 and 2023 for much-needed resources, that would give the stroke unit a chance to bring its level of care up to that required, were unsuccessful on both occasions. The National Clinical Programme for Stroke "views the situation at UHW as a significant concern". 

Acute Specialist Stroke Units (ASU) staffed with a stroke specialist multi-disciplinary team are recognised by the National Clinical Programme for Stroke as the "single most effective way of delivering improved outcomes for patients presenting to the hospital with a potential stroke".

Currently UHW has five dedicated ASU beds with two single side rooms. UHW underwent a registered audit over a three-month period in 2023 to evaluate the population presenting to the Emergency Department. 

Direct admission to the Acute Specialist Stroke Unit occurs in only 25% of all acute stroke patient presentations, and only 6% of transient ischemic attacks (TIAs). It falls far below what it should be - that all stroke patients should have immediate access to this unit, to give them the optimum chance for positive recovery outcomes.

60% of stroke admissions at UHW are eventually managed in the ASU, but those who get early access to the unit are shown to need significantly shorter lengths of stay, than those in non-stroke specialist wards.

Most significantly fewer patients admitted directly to the ASU died and more were discharged to the community rather than nursing homes, according to published data.

Stroke patients admitted to the ASU had an average length of stay of 13.9 days compared with those admitted to a non-stroke specialist ward, who had an average stay of 17.9 bed days.

Put simply, UHW needs as a matter of urgency the infrastructural development and resourcing to provide a 12 to 14 bed Acute Specialist Stroke Unit.

The number of admissions due to stroke has risen rapidly in recent years. In 2018 there were 139 acute stroke admissions at UHW. In 2023 this had jumped to 229. 

This current scenario cannot be allowed to continue into another year, without immediate action. The lives of Waterford people are being dangerously compromised each year, each month, each week that this is permitted by the HSE and the Department of Health to drag on.