The New Zealand Ministry of Health indicators for inpatient stroke care: results from an Auckland hospital.

Abstract

Aim: New Zealand's Ministry of Health sets three quality metrics for inpatient stroke care: admission to an organised stroke unit within 24 hours (target 80%), appropriate use of reperfusion therapy (target 12% for ischemic stroke) and transfer to rehabilitation services within 7 days (target 80%). Our aim was to evaluate a large Auckland tertiary hospital's performance against these indicators.

Methods: A retrospective study of 200 consecutive stroke patients admitted between April 4 and August 1, 2021, was conducted.

Results: Fifty percent (100/200) of patients were admitted to the stroke unit within 24 hours. Sixteen point six percent (27/183) of ischaemic stroke patients received reperfusion therapy. Twenty-four point five percent (49/200) were transferred to rehabilitation services, of which 40.8% (20/49) were within 7 days of presentation. Patients were less likely to be admitted to the stroke unit within 24 hours if not admitted by the stroke service, if admitted out-of-hours or if suffering an inpatient stroke. Timely admission to the stroke unit was associated with receipt of reperfusion therapy, shorter time to inpatient rehabilitation transfer and shorter duration of admission. Patients with inpatient stroke were less likely to be discharged in a timely manner (adjusted hazard ratio [HR] 0.19; 95% CI 0.07-0.50). All-cause mortality during a hospitalisation episode with a stroke diagnosis was likely to occur early in the admission (adjusted HR 1.82; 95% CI 1.01-3.32).

Conclusions: The hospital met the reperfusion therapy target but fell short on timely stroke unit admission and rehabilitation transfer. An after-hours effect on stroke unit admission was observed, previously undocumented in New Zealand.