National Stroke Audit: The Australian experience

Dawn Harris¹, Dominique A Cadilhac^2,3, Graeme J Hankey^4,5, Susan Hillier⁶, Monique Kilkenny^2,3, Erin Lalor¹ On behalf of the National Stroke Foundation and the National Stroke Audit Collaborative

¹National Stroke Foundation, Melbourne, VIC, Australia; ²National Stroke Research Institute, Heidelberg Heights, VIC, Australia; ³Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia; ⁴Royal Perth Hospital, Perth, WA, Australia; ⁵The University of Western Australia, Crawley, WA, Australia; ⁶The University of South Australia, Adelaide, SA, Australia

Background: National data measuring compliance with stroke clinical guidelines were unavailable in Australia until 2007. The inaugural National Stroke Audit was established to monitor the quality of clinical practices in acute stroke management.

Aim: To assess adherence to recommended care known to optimize health outcomes for people after experiencing acute stroke.

Methods: Public hospitals managing people with acute stroke conducted a retrospective clinical audit of up to 40 cases admitted between October 1, 2006 and March 31, 2007.

Results: Eighty-nine hospitals contributed clinical audit data on 2,724 people with acute stroke. Discrepancies between recommendations and clinical practice were evident. Half the patients audited were treated in a stroke unit. Often multidisciplinary interventions did not occur within two days, as recommended (46%–75%). Few (3%) patients with ischemic stroke received thrombolysis. Secondary prevention on discharge was inadequate: a quarter did not receive antihypertensives, a third did not receive lipid-lowering medication, and two-thirds did not receive lifestyle advice. Adherence to discharge planning processes was poor (11%–53%).

Conclusions: The audit has provided insights into the performance of the Australian health system on providing acute stroke care. These findings provide an opportunity to develop action plans for improving clinical practice and to monitor temporal progress.

Keywords: stroke, stroke unit, adherence, clinical audit