ACUTE STROKE PATHWAYS IN THE UK

Acute stroke pathways in the UK



Abstract

According to available data, fewer than 5% of the strokes occur in people under the age of 45 in UK. Stroke incidence studies in the young were reported in several surveys and a few community-based studies that used different methodology and results were often very different. Moreover, in many studies, reported incidence rates had wide confidence intervals because of the small number of incident cases in the young. This study aims to evaluate incidences of stroke in people by means of a systematic review of the literature.

Acute stroke pathways in the UK

Introduction

Over 132,000 people in the United Kingdom have a stroke each year, three-quarters of whom are aged over 65. Stroke is the third most common cause of death in the United Kingdom and the single most common cause of severe disability. The 'acute' stroke phase is defined as the first 30 days after stroke, during which nearly one-third of patients will die (Angeleri, 1993, 28).

The UK stroke service model reflects international principles of good practice including rapid admission to specialist, hospital-based stroke units, early access to specialist rehabilitation services, the transfer of ongoing inpatient rehabilitation into community settings and a range of long-term health and social care services that support life with stroke.

The National Clinical Guidelines for Stroke and National Stroke Strategy recommend that patients who are suffering from stroke should have access to specialists in the concerned subject and that staff providing this care receive appropriate training. As the stroke disease trajectory is variable, the challenge is to identify models of practice that support the timely integration of palliative care (Reynolds, 2004, 87).

The end of life care tools to guide practice recommended in the End of Life Care Strategy include the Liverpool Care Pathway (LCP) providing generic recommendations for terminal care. The applicability of the LCP to acute stroke has not been systematically evaluated, although it may improve prescribing practice and communication about prognosis (Roger, 1989, 58).

Probable information on the analgesic care needs of stroke patients is lacking. A critical review of the international literature identified seven studies, four of which were completed within the United Kingdom. Many patients did not receive optimal symptom control. Patients reported insufficient help to overcome psychological morbidity, and informal caregivers identified difficulty accessing information. The caring experience was distressful and unrewarding, with high reports of insufficient help. The review concluded that palliative care may have a role in the care of stroke patients and should be systematically provided on the basis of need.

The National Clinical Guidelines for Stroke make no distinction between those patients who die in the acute and later stages of the disease pathway, although these groups may require different palliative care strategies and interventions. In non-acute stroke, patients have some time to make plans for death, and professionals have opportunity to implement appropriate interventions. This study focuses on the palliative care needs of acute stroke patients about which little is ...