Hospital services for patients with acute stroke in the United Kingdom: the Stroke Association Survey of consultant opinion

Abstract

A national postal survey of all UK hospital consultant geriatricians, general physicians and neurologists was performed in 1992/3 in order to describe the provision of hospital stroke services in the United Kingdom and to assess whether the recommendations of the King's Fund consensus conference on stroke had been widely implemented. Of 3478 survey forms, 2923 (84%) were returned and, of these 1953 (67%) consultants indicated that they routinely cared for patients with acute stroke. On their stated estimates, the survey respondents had admitted approximately 107,000 patients with acute stroke in the previous year, 40% of whom were cared for by geriatricians. Sixty-three per cent (1239/1953) worked in District General Hospitals. Few (5%) had access to an acute stroke unit, and a majority (51%) of consultants were uncertain of the benefits of such units. Less than half (44%) had access to a specialized stroke rehabilitation unit, but a majority (68%) were certain of the benefits of stroke rehabilitation units. Although a majority of consultants had on-site CT scanning, about a third of all UK stroke patients were admitted to a hospital without on-site CT facilities. Most (90%) consultants would want a CT scan themselves if they had a stroke. Only about a third of consultants were aware of a recent audit of stroke care in their hospital, or had a hospital policy for the implementation of minimum standards of stroke care, and less than half routinely provided written information for patients or carers. This survey illustrated that five years after the publication of the King's Fund consensus statement on the treatment of patients with acute stroke UK hospital stroke services are still poorly organized. Access to CT scanning for stroke patients is improving, but is still insufficient.