“Considerable variation” exists in the time taken to provide stroke prevention surgery, data from the Royal College of Physicians and the Vascular Society has shown.
The college found time from referral to treatment for people showing symptoms of a stroke or mini-stroke differed significantly from trust to trust.
Just over half of patients, 57 per cent, received surgery within the National Institute for Health and Clinical Excellence standard of 14 days from referral.
The surgery can significantly reduce the chances of patients suffering a serious stroke or second mini-stroke.
The government’s National Stroke Strategy says that by 2017 trusts should be treating patients within 48 hours – a service only 12 per cent of patients received last year, the report said.
The audit reported an improvement in the median number of days from referral to operation, dropping to 12 from the 19 reported the previous year.
The report said 41 per cent of the cases missing the two-week time frame were due to “a delay in referral to specialist stroke centres or clinics”, 13 per cent to lack of imaging equipment and 17 per cent to “limited availability of staff or theatre time”.
It said: “Services need to be designed to meet the needs of patients, not the convenience of clinicians. This means having a team that can see and assess patients seven days a week. There needs to be rapid access to imaging [and] the surgical service needs to respond to the patient need for intervention quickly. This may mean patients cannot always be treated on elective operating lists.”
The audit, published on Tuesday, breaks down the data by organisation, for the first time.
Vascular Society audit chair and consultant vascular surgeon David Mitchell said: “The clinical community needs to collectively redouble its efforts and refine the pathway of care. NHS organisations will need to ensure rapid access to clinicians, imaging and surgical teams. Clinical teams will need to recognise [mini-strokes] as an emergency requiring rapid response to deliver high-quality care in a timely manner.”
The report is the third National Carotid Interventions Audit, which measures procedures to the neck to reduce the risk of a stroke, and takes its data from the 4,971 operations carried out between October 2009 and September 2010.
The report’s authors said there were problems with getting data from some trusts, and said the London, East of England and West Midlands regions had each reported to them less than three-quarters of the cases that showed up in their HES (Hospital Episode Statistics) data.
A spokesman for the North West London Hospitals Trust said: “We are delighted with this result, which ranks us best in the country for the cases reported. Close collaboration between A&E, stroke, radiology and vascular surgery teams has enabled us to achieve our target of 100 per cent of patients receiving surgery within 14 days of presentation. This compares very favourably with the national average of 40 per cent.
“Northwick Park hospital now offers a 7-day TIA clinic and daily liaison with the vascular team which ensures that patients are on a fast track pathway as soon as they present and have rapid access to the most appropriate intervention.
“With plans to further expand the service to become a vascular centre, we aim to do better still and deliver access to surgery with 48 hours of presentation for the majority of patients.”
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