Australian Stroke Coalition statement on Stroke Care during the COVID 19 crisis

April 24, 2020

Key points:
• The COVID-19 pandemic is having a significant impact on the delivery of bestpractice stroke treatment and care for Australian patients.
• Access to time-critical reperfusion therapies and dedicated stroke unit care, as well as quality rehabilitation services, is proven to save lives and reduce disability.
• It is critical we continue to provide patients with evidence-based stroke treatment and care during this crisis.

The Australian Stroke Coalition (ASC) is calling on Australian health services to maintain best-practice treatment and care for patients with stroke in the face of the coronavirus (COVID-19) pandemic.

This call comes following the widespread redesign of medical services and staffing in response to the pandemic.

Coalition members understand the need for increased resourcing and equipment to manage COVID-19, but this must not be to the detriment of the many thousands of Australians who will experience stroke this year. The systems and resources needed to effectively manage patients with COVID-19 must not stop us providing proven treatments for patients with other conditions, including stroke.

Stroke is a serious medical emergency, requiring urgent attention. With the right treatment at the right time, many people can recover from stroke.

Coalition members from across the country are reporting delays in the diagnosis and treatment of patients with stroke. Hospital emergency departments have been physically divided into parallel streams (e.g. respiratory and non-respiratory) and emergency ‘code stroke’ patients are placed in different streams based on their COVID-19 risk.

The infection control requirements for safe delivery of endovascular clot retrieval (ECR) need to be carefully designed to avoid delaying or preventing access to this time-critical treatment.

While appropriate protection of staff from COVID19 exposure is essential, the results of delaying time-critical stroke treatment by even a few minutes can have potentially catastrophic consequences on the long-term outcome for patients.

Building on time-critical stroke treatment, access to a dedicated stroke unit makes the biggest difference to patient outcomes following stroke. Stroke unit care is characterised by provision of care in one location by an interdisciplinary team including medical, nursing and allied health professionals with expertise in stroke.

Increasingly, members report specialised stroke units are being converted into COVID-19 wards or are being repurposed to accommodate system-wide changes in bed allocations. Stroke Unit staff are being redeployed to other areas of the hospital.

Dismantling geographically co-located stroke units and redeployment of specialist staff will affect the lives of Australians impacted by stroke and their families. It will put patients at risk of increased disability and death following a stroke. It will also increase length of stay and bed utilisation by stroke patients, reducing hospital patient flow. It is also essential that access to rehabilitation services is maintained to optimise patient outcomes and promote patient flow out of acute inpatient beds.

The Coalition applauds Governments and health services for recognising the potential for telehealth in response to the restrictions imposed by COVID-19. The Coalition has advocated for an Australian Telehealth Network (ATN) to provide regional and rural hospitals with emergency access to metro-based stroke specialists. We also welcome and support the expansion of telehealth for stroke rehabilitation services. It has been rewarding to see the potential of telehealth recognised throughout the care continuum, and the Coalition urges its continued use beyond the pandemic. Telehealth has significant potential for closing gaps in care for the vulnerable, and regional and rural Australians.

The ASC is calling on key stakeholders, including hospitals and health care administrators, to:
• work with stroke specialists to implement clinical pathways for rapid access to stroke reperfusion treatments which maintain the safety of staff and provide the best outcome for patients
• maintain geographically defined stroke units staffed by specialised medical, nursing and allied health professionals to provide evidence-based stroke care
• expand the use of telehealth for stroke rehabilitation services now and after this pandemic is over.

The Australian Stroke Coalition (ASC) is an alliance of stroke organisations and groups, established by the Stroke Foundation and the Stroke Society of Australasia (SSA), focused on improving stroke care and strengthening the voice for evidenced based stroke care at a national and state level. The ASC is issuing this statement to highlight the need for continued access to best-practice stroke treatment and care during the COVID-19 pandemic.