Nurse staffing levels in majority of stroke units ‘completely unacceptable’

A third of patients who have a stroke do not get access to an acute stroke bed, and nurse staffing levels in the vast majority of stroke units that have been set up across the State are “completely unacceptable”, the HSE’s national clinical lead for stroke services has said.

Prof Rónán Collins said there is an inadequate number of stroke beds across the system. “So for example, we still have a situation where over one third of patients who have a stroke, do not get into an acute stroke bed. Can you imagine if I said that to the heart attack community? Oh sorry, you can’t get into coronary care. We don’t have enough coronary care beds. It would be a national outcry, but for some reason it doesn’t seem to, I don’t know, excite people as much when it comes to when it comes to stroke beds.”

This is despite stroke being the third leading cause of death and the leading cause of disability in the State. The condition was responsible for 1,423 deaths in Ireland in 2021, and hospitalised more than 6,000.

Prof Collins said that of the stroke unit beds the State has, more than 80 per cent of them have inadequate nurse staffing to patient ratios and well more than half of them have inadequate therapy staff.

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In addition, he said the country is facing a 58 per cent reported increase in the number of strokes, and “our current stroke services are not fit for purpose”.

“It’s completely unacceptable to my mind that the nurse staffing in the vast majority of our stroke units is not up to what it should and that over or at least over half our units, have insufficient therapy staff, that’s not good enough either,” he said.

While improvements have been made in mortality in recent years, “we could be better”, he said.

Despite the challenges, and regular reports of overcrowding in emergency departments, he said people should immediately call an ambulance if they suspect someone is having a stroke.

“What I would say to you is that you have to seek emergency treatment if you suspect that you’re having a stroke, because literally minutes do matter. I would also say to people that the important thing is to ring the ambulance because we have a pre-designed stroke pathway, the ambulance will pre-alert the hospital and there will be a stroke assessment done immediately and you will have your scan done ASAP, we’ve set up all the acute hospitals like that. So even if the emergency department is busy, you’ll be whisked straight through for an emergency assessment, whereas the danger is that if you do nothing, we may not be able to do anything. If you do nothing and wait, and if you don’t call an ambulance and decide to come down yourself, you won’t have the same emergency pathway working,” he said.

He said the median time nationally by which a stroke patient arriving at the emergency department in this way gets seen, gets scanned and a decision made about treatment, is under an hour.

He was speaking as the Irish Heart Foundation urged people to act quickly in the event of a stroke.

Its head of advocacy, Chris Macey, said just 46 per cent of stroke victims are getting to hospital within the recommended three-hour window to receive clot-busting treatment despite quick action potentially meaning the difference between recovery, permanent severe disability or death.

“So the message we want people to get is above anything, you can have a huge impact on your outcome from stroke if you act fact,” he said.

“It’s very unlike really any other condition where if something happens to you, it is up to the doctors what your outcome is. Here, you can have a massive influence on your own outcome, but you have to know those signs of a stroke.

According to the Irish National Audit of Stroke 2021, although there has been an increase of three in stroke units from 21 to 24 since 2015, 88 per cent of these units operate below the recommended nurse staffing level. Some 46 per cent of hospitals have availability of on-call stroke teams 24 hours a day, seven days a week, however, 92 per cent of hospitals provide a thrombolysis service every day.

Most people who have strokes are over the age of 65, but strokes can strike at any age. A stroke occurs when a blood vessel, which is carrying oxygen and nutrients to the brain, bursts or is blocked by a clot.

Mr Macey added that having Pauline McLynn, famous for her role as Mrs Doyle on Father Ted, on board with the Fast campaign to raise awareness of what to do in the event of a stroke is “going to have a huge impact”.

“If she is giving the message, people are going to listen to it more, and her giving her time to use for this is going to save people’s lives, and is that not fantastic, and we are so grateful to her,” he said.