The push to improve stroke services

14599057094_556c720cf5_oAdhi Vedamurthy is a consultant geriatrician with a special interest in stroke, and Chair of the BGS Wales Council.

It was a typical Monday morning in a district general hospital. Loads of elderly medical patients had spent the night in the emergency department waiting for a bed. About a dozen ambulances were outside the hospital unable to offload patients.

I had just done a third of my ward round with the foundation year one doctor when the bleep went off. A patient with potential need for thrombolysis had just arrived. Apart from the stroke nurse, there was no other suitable senior doctor available to assess the patient.

I abandon the ward round to assess the patient, organise the scan, push the trolley with the stroke nurse to take the patient to the stroke unit and initiate thrombolysis. This takes nearly an hour. During this time, the patients on the ward are still waiting for my assessment and management plan. Two discharges get delayed and a few scans were not booked on time and they had to wait for another day.

This scenario is very common in many hospitals where geriatricians have more than one role. Time is of the essence when treating stroke patients, but this comes at a cost if commissioners do not invest to improve services and expect existing services to stretch. This also applies to therapy services who are asked to prioritise stroke patients.

To meet targets, a patient with a suspected stroke (many do not have a stroke) must get a bed in a stroke unit within four hours. But it seems entirely acceptable for patients with heart failure, pneumonia, a fall, delirium, etc., who have far higher mortality, to spend hours on a trolley in the emergency department.

There is no argument that acute stroke is an emergency and should be treated accordingly. However this should not come at the expense of other services in geriatric medicine.

A majority of geriatricians in Wales felt that an improvement seen in stroke services has come at the cost of compromising services in geriatric medicine.

Is this the case in the other devolved nations? I would love to hear your views.

Newsflash: Acute Care system fails an older patient, reflections from a relative

Ron Murphy is a software designer, he blogs at ronmurp.netthumbnail

An older patient presenting acutely to A&E in an unwell and frail state can erroneously be assumed to be at their baseline pre-morbid state, with some additional new complaint like a “UTI” as an over-riding diagnosis. My active and mobile mother was reduced over a period of three months to a delirious crumpled wreck who didn’t know what day it was because of a persisting UTI that had not been dealt with. Her past medical history was complicated: stroke, heart attack, pacemaker, diverticulitis, arthritis, diabetes not well controlled, kidney function not right … you get the picture. But still, before the UTI she was sharp and active.

What follows is a brief account (you don’t want the detailed version) of what happened in A&E on three failed visits. Continue reading