New clinical care standard for acute stroke

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Launched in June 2015, the Australian Commission on Safety and Quality in Health Care (the Commission) launched the new Acute Stroke Clinical Care Standard. The Standard aims to improve the early assessment and management of patients with stroke to increase their chance of surviving the stroke, to maximise their recovery and to reduce their risk of another stroke.

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Stroke affects thousands of Australians each year and is a major cause of death and disability. Acute stroke was the underlying cause of 8800 deaths in 2011, which is 6% of all deaths for the year.1 The impact of stroke on survivors is high – over a third of Australians who have experienced a stroke have a resulting disability.¹
Receiving the right care at the right time and in the right place can significantly improve an individual’s chance of surviving a stroke and recovering to lead a full and independent life.² [pull quote] Current data show that despite well developed guidelines, not everyone with stroke receives the recommended care.³
Clinical Care Standards are small sets of concise recommendations (‘quality statements’) that aim to ensure a shared understanding by patients, clinicians and health services of the care that should be offered. They help patients know what care may be offered by their healthcare system, support clinicians make appropriate decisions about care and support health services examine the performance of their organisation and make improvements in the care they provide.
The Acute Stroke Clinical Care Standard consists of seven quality statements which have been developed for use in hospitals and pre-hospital settings:

1. A person with suspected stroke is immediately assessed at first contact using a validated stroke screening tool, such as the F.A.S.T. (Face, Arm, Speech and Time) test.


2. A patient with ischaemic stroke for whom reperfusion treatment is clinically appropriate, and after brain imaging excludes haemorrhage, is offered a reperfusion treatment in accordance with the settings and time frames recommended in the Clinical guidelines for stroke management.


3. A patient with stroke is offered treatment in a stroke unit as defined in the Acute stroke services framework.


4. A patient’s rehabilitation needs and goals are assessed by staff trained in rehabilitation within 24-48 hours of admission to the stroke unit. Rehabilitation is started as soon as possible, depending on the patient’s clinical condition and their preferences.


5. A patient with stroke, while in hospital, starts treatment and education to reduce their risk of another stroke.


6. A carer of a patient with stroke is given practical training and support to enable them to provide care, support and assistance to a person with stroke.

Before a patient with stroke leaves the hospital ,they are involved in the development of an individualised care plan that describes the ongoing care that the patient will require after they leave hospital. The plan includes rehabilitation goals, lifestyle modifications and medicines needed to manage risk factors, any equipment they need, follow-up appointments,and contact details for ongoing support services available in the community. This plan is provided to the patient before they leave hospital, and to their general practitioner or ongoing clinical provider within 48 hours of discharge.
The Acute Stroke Clinical Care Standard was developed by the Australian Commission on Safety and Quality in Health Care (the Commission) in collaboration with consumers,clinicians, researchers and health service organisations. It is the third Clinical Care Standard to be released – Clinical Care Standards on Acute Coronary Syndromes and Antimicrobial Stewardship are also available.
The Commission has developed a range of resources for clinicians and health services to assist with implementation of the Acute Stroke Clinical Care Standard, including indicators for local monitoring and evaluation, and fact sheets for clinicians and patients.

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“Receiving the right care at the right time and in the right place can significantly improve an individual’s chance of surviving a stroke and recovering to lead a full and independent life.²"

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For more information,and to download the Acute Stroke Clinical Care Standard and resources, visit safetyandquality.gov.au/ccs
References
1. Australian Institute of Health and Welfare.Australia’s health 2014. Canberra: AIHW; 2014 [accessed 25 February 2015]; Australia’s health series no.14. Cat. no. AUS 178.
2. National Stroke Foundation. Clinical Guidelines for Stroke Management. Melbourne: NSF; 2010.
3. National Stroke Foundation. National Stroke Audit: Acute Services Clinical Audit Report.Melbourne: NSF; 2013