22. European Stroke Conference 355 Management and economics Global availability of stroke unit care; a survey of participants in the INTERSTROKE study P. Langhorne1, S. Chin2, M. O’Donnell3, H. Zhang4, D. Xavier5, A. Avezum6, M. Mathur7, S. Yusef8 INTERSTROKE collaborators Glasgow University, Glasgow, UNITED KINGDOM1, Population Health Research Institute, Hamilton, CANADA2, NUI Galway, Galway, IRELAND3, Beijing Hypertension League Institute, Beijing, CHINA4, Medical College and Research Institute, Bangalore, INDIA5, Institute of Cardiol-ogy, Sao Paulo, BRAZIL6, Medical College and Research Institute, Bangalore, INDIA7, Population Health Research Institute, Hamilto, CANADA8 Background: Stroke is a global healthcare problem. Most people experiencing stroke now live in lower income countries and this figure is expected to increase. Many recent stroke service develop-ments have taken place in high income countries, but little is known about the broader international picture. We studied stroke services across 30 countries among hospitals contributing to the INTER-STROKE multicentre study of risk factors for stroke. Methods: We developed, piloted and circulated (with the aid of the national study coordinators) a stroke service questionnaire which covered local and national healthcare systems, hospital charac-teristics, and stroke service characteristics. This was circulated in July 2011 with a reminder sent in June 2012. Results: Of 147 sites that have recruited participants to INTERSTROKE, 21 had closed prior to the survey and 24 did not provide data. Of the remaining 102 sites with data, 54 (53%) reported having a stroke unit which was usually described (by >85%) as being in a discrete ward, staffed by a spe-cialist multidisciplinary team, with programmes of education for staff and protocols to guide patient management. The stroke units had a median number of 15 beds for a median of 40 stroke patients admitted to hospital per month. Stroke units were more commonly present (P<0.001) in high income countries (35/37 hospitals), particularly in Europe, Canada and Australia (35/35) compared with Asian countries (9/24), Africa (3/8), Latin America (7/28) or the Middle East (0/7). Following initial management in the acute hospital 47/102 (46%) reported no access to continuing specialist rehabili-tation. 474 © 2013 S. Karger AG, Basel Scientific Programme Conclusions: The availability of stroke unit care and subsequent access to rehabilitation varies great-ly between contributing hospitals in different countries. 356 Management and economics FAST – still too slow I. Kane1, T. Bowen2, P. Forte3, N. Gainsborough4 Brighton and Sussex University Hospitals Trust, Brighton, UNITED KINGDOM1, The Bal-ance of Care Group, , UNITED KINGDOM2, The Balance of Care Group, , UNITED KINGDOM3, Brighton and Sussex University Hospitals Trust, Brighton, UNITED KINGDOM4 Background: there is good evidence that the earlier a patient with an acute ischaemic stroke receives thrombolysis (where appropriate) the better the clinical outcome. Processes within hospital can be targeted to reduce door to needle times. However, what can be done to speed up the time taken for a patient to contact medical services? In the UK a 3 year public stroke awareness campaign was in-troduced in 2009 (at a cost of £105 million) based on the FAST acronym; ‘Face, Arms, Speech & Time to call 999’. At the Royal Sussex County Hospital (RSCH) we looked at time to presentation to medical services & times to investigations & treatment over 2 consecutive years during the FAST campaign as part of the EU funded Managed Outcomes project. Methods: the stroke team at RSCH maintain a comprehensive stroke database. The anonymised data for 2010-11 & 2011-12 were submitted to the Managed Outcomes team. A number of parameters were looked at, but here we report on 2 – percentage of patients with acute stroke symptoms pre-senting to first medical contact (primary or secondary care) within 3 hours & number of CTs per-formed within an hour of hospital presentation (as an indicator of in-hospital processes). Results: number of strokes presenting 2010-11:495 (83% ischaemic), 2011-12:502 (83% ischaemic). Percentage of strokes presenting within 3 hours to first medical contact:55% (2010-11); 54% (2011- 12). CT heads performed within an hour:106 (21%, 2010-11);192 (38%, 2011-12). 31 patients were thrombolysed each year. Conclusions: our data suggest that despite an expensive high profile public campaign patients with acute stroke are not seeking medical help any quicker. However, in-hospital processes have im-proved as reflected by the number of patients receiving early brain imaging. Some work has been done on whether public understanding of stroke has improved with the FAST campaign, but our data indicate, that in this area of the South East at least, we have a lot more work to do.
Karger_ESC London_2013
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