An evaluation of stroke services at Zammit Clapp hospital

Abstract

Introduction: The management of older persons with stroke has evolved to be a highly specialised area, which requires an interdisciplinary care approach. At Zammit Clapp Hospital (ZCH), the management of patients with stroke forms an important part of the patient caseload. The aim of this study was to describe the characteristics of stroke admissions and their outcome and to compare these with a control group.

Methodology: A prospective observational study on all patients admitted with acute stroke during the period 1 May 1998 to 31 April 1999. The study was performed on patients who were admitted to St. Luke's Hospital and subsequently transferred for further management at ZCH. A diagnosis of stroke according to WHO criteria within the previous 48 hours of admission to the acute hospital was required for inclusion. Data was collected by assessment of patients using the Royal College of Physicians clerking proforma for stroke admissions, by recording observations from the medical case notes, nursing notes and observation charts and by feedback from interdisciplinary case-conferences. Results: There were 107 acute stroke admissions (11.27%) out of 1003 total admissions during the one-year study period. There were 68 females and 39 males, equivalent to a ratio of 1. 74: 1. The mean age for males was 76.8 years and 77.9 years for females. The mean duration of stay in hospital was 16.5 days (SD 11.7) at SLH and 33.3 days (SD 21.0) at ZCH, while that of controls was 20.9 days at SLH and 20.0 days at ZCH. 77 patients (72%) were discharged to the community, 19 patients (17.7%) were discharged to community homes, 7 patients (6.6%) required admission to St. Vincent de Paule and 4 patients died in hospital (3.7%). The mean Barthel Index for stroke patients was 6.68 on admission improving to 11.44 on discharge. The figures for the control group were 11.54 and 14.41 respectively. Complications occurring significantly more frequent in the rehabilitation phase included chest infection (21 patients), pressure ulceration of the skin (25 patients), depression (18 patients), shoulder pain (11 patients) and falls (35 patients). Other complications included Urinary tract infections (23 patients) and thromboembolic disease (3 patients).

Conclusions: ZCH plays an important role in the management of elderly patients with stroke. Patients with stroke require a longer hospital stay and have more complications than patients with other diagnoses. An improvement in functional ability was seen with all grades of stroke but to a lesser degree than controls. Patients with stroke were more likely to remain dependent, to need more care and ultimately to require transfer to nursing homes or long-term care. ZCR's expertise with regards to number of patients treated and their outcomes, services available and staffing levels, can be considered as fulfilling its role in providing specialist stroke rehabilitation services to older persons.