To ask the Scottish Executive what percentage of patients experiencing strokes is (a) blue light transferred to hospital with a pre-alert to the receiving unit, (b) offered a CT scan, (c) offered a CT scan within three or four hours, (d) admitted directly to a specialist hyper-acute stroke unit within 24 hours, (e) given thrombolysis therapy within three or four hours of onset and (f) given early multidisciplinary assessment, including swallowing screening within 24 hours and identification of cognitive and perception problems.
The information requested in part (a) of the question is not available. A key performance indicator (KPI) for ensuring rapid transfer and assessment of patients presenting with acute stroke is however being developed. The Scottish Stroke Care Audit (SSCA) will monitor NHS boards'' progress against that indicator.
The updated NHS QIS stroke standards published at the end of June stipulate that thrombolysis services should be aiming to treat more than five stroke patients per 100,000 population and to ensure that the door-to-needle time is less than one hour in at least 80% of patients treated. In anticipation of this, SSCA started collecting data in January 2009 on all patients thrombolysed in Scotland. The first data should be published in summer 2010.
The further information requested in the question is not held in exactly the format requested, but the information we do hold is presented here in the most appropriate way possible. The Scottish Stroke Care Audit database captures information on the percentage of stroke patients undergoing scanning during admission (including CT scan but also other forms), admission to any stroke unit within one day of admission and swallow screening on the day of, or within one day of, admission. The most up-to-date information can be found in the 2008 SSCA national report and is shown in the following table:
NHS QIS Stroke Standards (March 2004)
| Indicator* | | Audit Period |
| 2005 | 2007 |
| Stroke Patients (denominator for percentages) | Number | 7,409 | 7,954 |
| Swallow screen during admission | Number | 4,774 | 5,510 |
| Percentage | 64 | 69 |
| Swallow screen on day of admission | Number | 3,289 | 3,965 |
| Percentage | 44 | 50 |
| Swallow screen within one day of admission | Number | 4,172 | 5,000 |
| Percentage | 56 | 63 |
| Scanned during admission | Number | 6,997 | 7,624 |
| Percentage | 94 | 96 |
| Scanned within two days of admission | Number | 5,809 | 6,893 |
| Percentage | 78 | 87 |
| Admitted to stroke unit within one day of admission | Number | 3,785 | 4,437 |
| Percentage | 51 | 56 |
Source: Scottish Stroke Care Audit (SSCA) 2008 National Report.
Notes:
* includes missing data in the denominator; in general NHS QIS adopt the more rigorous standard where the denominator includes those with missing data i.e. if it is not recorded that something was done then it was assumed that it was not.
Data for 2006 are not available, as the SSCA agreed a data collection amnesty that year to allow hospitals with data entry backlog to focus on collecting audit data for 2007.
The issues raised in the question are highlighted in our Better Heart Disease and Stroke Care Action Plan, published in June 2009.