Platform Presentation The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Championing stroke care: Insights from the Australian Stroke Clinical Registry on priority areas of Acute Stroke Care. (#4)

Dominique A. Cadilhac 1 2 , Lachlan Dalli 2 , Julie Morrison 1 , Natasha A. Lannin 2 3 , Kate Paice 1 , Bruce CV. Campbell 4 , Geoffrey C. Cloud 2 3 , Monique F. Kilkenny 1 2 , Helen M. Dewey 2 5 , Kelvin Hill 6 , Geoffrey A. Donnan 4 7 , Rohan S. Grimley 8 , Timothy Kleinig 9 , Sandy Middleton 10 11
  1. Stroke theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
  2. Monash University, Clayton, VIC, Australia
  3. Alfred Health, Melbourne, Victoria, Australia
  4. Royal Melbourne Hospital, Parkville, Victoria, Australia
  5. Eastern Health, Box Hill, Victoria, Australia
  6. Stroke Foundation, Melbourne, Victoria, Australia
  7. University of Melbourne, Parkville, Victoria, Australia
  8. Sunshine Coast Clinical School, Griffith University, Birtinya, Queensland, Australia
  9. Royal Adelaide Hospital, Adelaide, South Australia, Australia
  10. Australian Catholic University, Sydney, NSW, Australia
  11. Nursing Research Institute, St Vincent's Health Network, Sydney, NSW, Australia

Background: The Australian Stroke Clinical Registry collects information on national acute stroke care standards. Variation in care between hospitals impacts patient outcomes.

Aims: To illustrate hospital performance in four priority areas of acute stroke care (stroke unit treatment, time to neuroimaging, thrombolysis door-to-needle time (DTNT), and swallowing assessments).

Methods: Across 7 states/territories, 60 adult public hospitals provided 2021 data. Adherence was determined as the percentage of eligible patients treated. Funnel plots were used identify exceptional (>3 standard deviations above national average) and poor (>3 standard deviations below national average) performance. For continuous outcomes (neuroimaging timing or DTNT), we described hospitals with performance outside of the national interquartile range.

Results: Overall, 16,458 episodes of stroke were analysed (median age 75 years, 43% female, 81% ischaemic). There were 27 hospitals with exceptional adherence to stroke unit care, 13 with poor adherence and 3 with no episodes treated in a stroke unit. Stroke unit treatment was less common in regional hospitals (68% vs metropolitan 80%, p<0.001). Median time from arrival to neuroimaging was 41 minutes, 2 hospitals were above the 75th percentile (>87 minutes) and 5 hospitals were below the 25th percentile (<20 minutes). Among 1320 patients with ischaemic stroke who received intravenous thrombolysis, the median DTNT was 77 minutes. Only 5 (8%) hospitals had a median DTNT ≤60 minutes, 4 (7%) below the 25th percentile (56.5 minutes), while 18 (30%) had DTNT above the 75th percentile (107 minutes). Only 58% of all patients had their swallowing screened/assessed prior to oral intake; and 29% within 4 hours of arrival (9 hospitals with exceptional adherence; 12 with poor adherence).

Conclusion: Despite strong evidence for recommended acute stroke care practices, there remains significant variation between Australian hospitals. The standardised registry data are essential to identifying areas for improvement against national benchmarks and to support stroke unit certification.