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Only half of stroke services have enough nurses

Patients are missing out on the best possible care due to a critical shortage of nurses and consultants, experts from a national audit programme have concluded.
stroke services

People who have had a stroke are missing out on the best possible care due to a critical shortage of nurses and consultants, a major audit has concluded.

Experts from the Sentinel Stroke National Audit Programme (SSNAP) warned that only half of stroke services have an adequate number of nurses on their stroke units.

Research has shown that having fewer nurses is linked to more patient deaths.

As a minimum, there should be 2.375 nurses at a band 6 or 7 for every 10 stroke beds, but only 51% of sites currently meet this target.

On weekends, only 20% of sites have the right number of nurses for the most acutely ill patients and those receiving continuing care.

People who have had a stroke are missing out on the best possible care due to a critical shortage of nurses and consultants, a major audit has concluded.


The Stroke Unit at St George’s Hospital in South London was named
the best stroke unit in the country in 2010. Picture: Nathan Clarke

Experts from the Sentinel Stroke National Audit Programme (SSNAP) warned that only half of stroke services have an adequate number of nurses on their stroke units.

Research has shown that having fewer nurses is linked to more patient deaths.

As a minimum, there should be 2.375 nurses at a band 6 or 7 for every 10 stroke beds, but only 51% of sites currently meet this target.

On weekends, only 20% of sites have the right number of nurses for the most acutely ill patients and those receiving continuing care. There should be at least three registered nurses on duty per 10 stroke beds at the weekend.

Insufficient levels

Experts from SSNAP, which covers stroke care provided to patients in England, Wales and Northern Ireland, said staffing levels were ‘a concern’.

‘Senior nurses are essential not only for ward management, but also for taking charge of the ward overall, maintaining standards of care and ensuring more junior staff are appropriately trained in the management of acute stroke,’ the report said.

‘Current nurse staffing levels are insufficient to provide good care for everyone who needs it, and as we implement guidelines, more skilled nurses will be required rather than less.’

There were also problems with recruiting consultants, with 40% of stroke services having an unfilled stroke consultant post – up from 26% in 2014.

More than a quarter of patients did not receive a swallowing test within 4 hours, despite needing one.

There have been some improvements in access to thrombolysis (when clots are targeted with drugs), caring for people having a transient ischaemic attack (TIA) or ‘mini stroke’, and access to brain scans, with 90% scanned within 12 hours of arrival.

Thrombectomy, where surgeons use tiny tools to break a blood clot into pieces that can be sucked out of the blood vessel, is only available in a limited number of units and only on weekdays.

Better outcomes

RCN professional lead for older people and dementia care Dawne Garrett said the shortages of nurses on stroke wards was worrying.

‘Stroke is a major cause of long-term disability and there is quite a short window to ensure that optimal care is given and to prevent future disability, which has a massive impact on the person and society.

‘We know that there are significantly better outcomes for patients who have had a stroke if they are cared for by registered nurses. It is not just about quality of care, it is about the outcome for patients.’

Royal College of Physicians clinical quality improvement department associate director for stroke Pippa Tyrrell said: ‘Stroke care has improved beyond recognition in the past 20 years. However, we still have marked variation of services and patient outcomes across the UK.’


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