How we can beat the postcode lottery for stroke care

Every 19 minutes, somebody in Australia experiences a stroke for the first time. Regional Australians are 17 per cent more likely to suffer a stroke than those in metropolitan areas. 

Unfortunately, the difference between a strong recovery or a lengthy rehabilitation may come down to where the person lives, and the hospital where they're treated. 

At the Australian Stroke Clinical Registry, we’ve gathered hospital data that show that in many places, numerous patients are missing out on appropriate stroke care, and this is amplified in regional locations.  

The good news is, I believe we can beat the postcode lottery for acute stroke treatment, and ensure patients get the minimum standards of care they deserve.  

Our data are helping to shine a light on areas that hospitals can target for improvement, as well as highlighting areas where hospitals in different states are leading the way and can help others. In a recent survey, 81 per cent of our contributors stated their hospitals had quality improvement initiatives underway for stroke and most had used our reports to inform these activities. 

All of the hospitals that invite us to monitor their stroke data are dedicated to meeting national benchmarks for the level of care they should be providing patients, in line with international best practice. 

These benchmarks include whether the patient receives clot-busting treatments for stroke caused by a blocked artery in the brain, whether they are managed in a stroke unit, have a care plan when they are discharged, and whether they are provided with blood pressure lowering medication on discharge. 

In top performing hospitals, 99 per cent of patients returning home from hospital receive a written plan outlining their care following discharge. But our latest data show that only happened for 75 per cent of metropolitan and 53 per cent of regional patients. 

At least 90 per cent of patients should be managed in a stroke unit, but only 61 per cent of regional and 80 per cent of metropolitan patients received this kind of care. 

And 94 per cent of patients should receive blood pressure medication on discharge, but only 74 per cent of regional patients and 77 per cent of metropolitan patients did. 

Although participating hospitals have shown challenges in providing various aspects of stroke care, in 6 out of 9 of these achievable benchmarks, there was positive news for different jurisdictions.  

• Participating Australian Capital Territory hospitals were above average for the proportion of patients managed in a stroke unit, and the proportion who received a care plan on discharge.  

• Participating Queensland hospitals were above average for several measures including for the number of patients managed in a stroke unit and the proportion given a clot retrieval procedure.  

• Participating South Australian hospitals had the largest proportion of patients treated with clot-busting medication within the recommended 60 minutes of arrival, and the greatest proportion of patients who received a care plan at time of discharge.   

• Participating Tasmanian hospitals were above average in several measures and were more likely to provide antihypertensive medication on discharge than those in other states.  

• Participating Victorian hospitals had the overall highest proportion of patients treated with clot-busting medication.   

• Participating Western Australian hospitals were above average in several measures including having the greatest proportion of patients (90 per cent) managed in a stroke unit, and the highest proportion (98 per cent) to receive antithrombotic medication at discharge. 

The Australian Stroke Clinical Registry is working with the Australian Stoke Coalition and various state governments to improve stroke care. Work is already underway as part of the National Stroke Targets initiative to reduce the postcode lottery. Our team is at the forefront in providing hospital clinicians with near real-time data dashboards to monitor care and their performance against benchmarks. 

In Queensland, we support the StrokeLink program delivered in partnership with the Stroke Foundation that provides additional support to hospitals via in person workshops to understand their data, identify barriers to best practice and develop an action plan to address the issues identified.  

In Victoria, we are working with Safer Care Victoria as part of their 100,000 lives initiative to understand, monitor and improve the quality of acute stroke care in Victorian hospitals.  

Nationally, we run quality improvement workshops, webinars and forums for participating clinicians to share experiences and learn from top-performing hospitals. 

By monitoring how well hospitals are providing best-practice stroke care to patients, timely feedback to clinicians, learning from top-performing hospitals and support and having partnerships with each jurisdiction, I am confident we can improve the quality of stroke care for all Australians – and beat the postcode lottery.