Benchmarking local practice in view of introduction of thrombolysis for stroke in Malta

Abstract

The aim of the study was to benchmark the quality of local stroke care in view of introduction of thrombolysis. Stroke patients admitted to Mater Dei Hospital over 6 weeks in 2008 were recruited. A questionnaire based on the 2006 Royal College of Physicians (RCP) National Sentinel Stroke Audit phase II (Clinical Audit) was used. Results were compared to the 2008 RCP National Sentinel Stroke Audit phase II (Clinical Audit) report. 42 confirmed strokes were admitted. All patients underwent CT scanning within 24 hours. 97% received aspirin within 48 hours. 26.2% spent >50% of their stay in the neurology ward. 81% were discharged alive. At 24 hours from admission, 54.7% were not screened for swallowing. 47.6% were not assessed by an occupational therapist. 81% were assessed by physiotherapy at 72 hours of admission. None of the patients had documented goals set by a multi- disciplinary team. If thrombolysis were available, 16.7% would have been eligible. The commonest contraindications were late presentation (52.4%) and age >80 years (35.7%). Local results compared well to the RCP 2008 results in initiation of aspirin, imaging, and nutrition. However, we noted need for improvement in the assessment of swallowing, mood and cognitive function as well as involvement of a multidisciplinary team. Since then, adherence to international guidelines has improved by the introduction of thrombolysis, a dedicated multidisciplinary service and the use of local guidelines for stroke.