Improving Australian Stroke Care and capturing changes to stroke care during the COVID pandemic

September 11, 2020
The Australian Stroke Clinical Registry (AuSCR) is a decade-long, national effort to deliver best practice care for people experiencing stroke. AuSCR recently marked dual milestones, celebrating 10 years of operation and 100,000 recorded cases of stroke care.

AuSCR collects essential information on care given to someone who has experienced stroke or transient ischemic attack (‘mini stroke’), covering their journey from first presentation to hospital through to health outcomes 3-6 months down track.

Real-time monitoring enables individual hospitals to identify and fix ‘gaps’ in treatment processes for patients with stroke, as well as benchmark how their care and patient outcomes compare to other hospitals around Australia at any given time.

Custodian of the registry, Professor Dominique Cadilhac from the Florey Institute of Neuroscience and Mental Health, says the evidence is clear that initiatives like AuSCR work.

“We know that providing the best standard of care to patients hospitalised after stroke can lead to better outcomes, such as decreasing disability, preventable deaths and risk of recurrent stroke in the longer term.”

“We continuously see improved stroke care in hospitals that take insights from the registry and implement quality improvements.”

74 Australian hospitals actively use the registry.

Two episodes of stroke – only months apart in 2019 – were captured on the registry for Rosanna resident, Tim McCartin. The former high school principal considers himself very lucky to have since made a full recovery and is an advocator of research initiatives, such as the registry, that aim to improve care for people who have experienced stroke.

"During my time in hospital and rehabilitation I saw firsthand how devastating stroke can be for a lot of people and their families," said Mr McCartin.

"When I learnt of the registry from a stroke nurses in hospital, I thought why not use my experience to be a part of something that can help other people who have had a stroke,” he explained.

Melbourne neurologist and Clinical Lead for the Victorian Stroke Clinical Network, Professor Peter Hand, also commented on the milestone.

“What we have been able to achieve for patients with stroke and their families over the past ten years has been momentous.”

“The registry has been a pivotal tool in directing where state government initiatives can focus to improve stroke care and policy, with the ultimate goal to achieve the best possible stroke treatments for all Victorians,” he said.

In addition to informing clinical care standards, data is also used in vital stroke care research including the Florey Institute’s work into understanding risk factors for stroke, effect of exercise on recovery post-stroke and other studies.

Most recently, the Australian Stroke Clinical Registry has been monitoring consequences to stroke care caused by the COVID-19 pandemic.

Preliminary analysis from a survey, in which 54 hospitals from six states and the ACT responded, found people were presenting less often to hospital for suspected episodes of stroke, particularly if they had experienced minor stroke or transient symptoms.

Additionally, the survey highlighted reports of stroke units being reduced in size or moved and specialist staff deployed to other duties.

Professor Cadilhac urged people to be vigilant about seeking medical care for stroke.

“If you suspect a stroke, don’t let COVID-19 stop you from going to hospital. If you or someone else experiences signs of stroke, call 000 immediately," she said.

AuSCR was established by a consortium of four groups; The Florey Institute of Neuroscience and Mental Health, The George Institute, Stroke Foundation and Stroke Society of Australasia.

Preliminary data from COVID-19 stroke survey

Worldwide, the COVID-19 pandemic has impacted stroke services and the number of patients presenting to hospital with stroke. To aid in understanding the initial impacts to local stroke care in Australia, a COVID-19 Survey was distributed electronically to AuSCR hospitals during May.

62 responses from 54 hospitals participating in the AuSCR across 6 states and territories were received. Responders reported the following changes to stroke care in their hospitals:

· About half reported reduced presentations, in particular for mild stroke

· Almost one in three reported longer time from stroke onset to presentation

· One in three claimed there had been changes to patient flow and management in the Emergency Department

· One in four indicated that their stroke unit had moved and one in 10 had a reduced bed capacity for patient with stroke

· Over one in four states that stroke specialist staff had been redeployed to work in other roles within the hospital

Preliminary patient-level data from the AuSCR obtained between 1 January - June 2020, compared with the same period in 2019, showed the following impacts on time to hospital presentation, as well as delays to treatment following arrival to hospital:

· Increased time from stroke onset to hospital arrival, particularly in Victoria and Queensland

· Decreased access to stroke unit beds

· Fewer patients treated with intravenous thrombolysis in under 60 minutes from arriving to hospital

With the ever-changing status of COVID in different jurisdictions, AuSCR is positioned as a valuable tool in monitoring hospital care for patients with stroke and use of hospital resources. A follow-up COVID hospital survey to assess ongoing local hospital changes to stroke care is expected later this year.