Stroke Foundation audit makes ‘concerning’ findings

December 12, 2023

A new Stroke Foundation audit of around 100 acute hospital services across Australia has found that our nation is falling well below international standards and not meeting national benchmark treatment times that are set to ensure people receive the best treatment and reduce death and disability.  
The 2023 National Stroke Audit is a snapshot of acute stroke care provided within Australian hospitals, highlighting where the system is working well and identifying where improvement is needed.  

 “Australia aims to deliver some of the best acute stroke care in the world but what these results show us is that we can do better in giving Australians the best chance of survival and living well after stroke. We do not want Australians slipping through the gaps in stroke care.” 
Among the key findings was that the median time from stroke onset to arrival in the emergency department is four hours and 24 minutes which is six minutes longer than in 2021 and significantly longer than the 2019 pre-covid results of three hours and 36 minutes. 
It also highlighted that almost three in every ten stroke patients who arrived in hospital were first admitted to a general medical ward rather than an acute stroke unit and access to stroke unit care has stagnated and is nowhere near the national target of 90 per cent. 
“Our stroke teams do a wonderful job caring for stroke patients but it is evident, through this audit, that there is a way to go in the delivery of best practice treatment and care. This year’s findings showed limited improvement on last year, but we’re committed to working with hospitals and governments to change that.”  
The audit has put forward recommendations, including the need for better system-wide coordination of services, earlier access to time-critical therapies and improved access to stroke unit care. 
“Together we can improve the state of stroke in Australia to reduce death and disability caused by stroke and ensure stroke patients are given the best possible chance of survival and a good recovery."

Key Findings of the 2023 National Stroke Audit Acute Services Report  

  • Access to stroke unit care has remained unchanged (72% in 2023 vs 73% in 2021). Receiving treatment in a dedicated stroke unit is the greatest determinant for better treatment outcomes and prognosis. 
  • Only 48% of patients received 90%+ of their acute care in a stroke unit (54% in 2021), significantly below rates achieved in other advanced countries (for example 73% in England). 
  • Only 38% of all patients with acute stroke reached hospital within the critical 4.5-hour time window for acute stroke treatment. Similarly, to the 2021 results, this indicates that not enough Australians are aware that stroke is a time-critical medical emergency.  
  • Only 29% of patients receive thrombolysis within 60 minutes of arrival in hospital (27% in 2021), and well below rates achieved in the UK and US (both above 60%). 
  • Reperfusion treatments (intravenous thrombolysis and/or endovascular thrombectomy), have not increased in Australia in 2023 with 4,815 receiving these therapies (4,899 in 2021). 
  • Thrombolysis provision was lower in inner regional hospitals (9%) and outer regional hospitals (7%) compared to hospitals in major cities (12%).  
  • Number of patients receiving comprehensive discharge care plans to maximise their recovery has declined (70% in 2023 vs 76% reported in 2021,). 
  • 28% of patients were not given advice on lifestyle and other modifiable risk factors to avoid another stroke. 

Results are similar to the annual report data due to be released by the Australian Stroke Clinical Registry (AuSCR). The Registry provides data on over 17,000 stroke episodes during 2022. Combined, these data highlight more needs to be done to improve outcomes for people impacted by stroke.