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THE DETRIMENTAL IMPACT OF NOT MAINTAINING ACCESS TO STROKE UNITS DURING THE COVID-19 PANDEMIC
Abstract
Background and Aims
Changes to hospital resourcing related to acute stroke care have occurred as a by-product of the COVID-19 pandemic. There is uncertainty on the impacts this has had on the quality of care. We aimed to compare the provision of acute stroke care provided in stroke units with alternate ward settings during the pandemic.
Methods
Patients admitted with stroke or transient ischaemic attack from 61 hospitals contributing data to the Australian Stroke Clinical Registry in 2019 and 2020 were included. Interrupted time series analysis was conducted to assess trends in the provision of therapies before and after two critical pandemic time points in Australia: the first wave (starting 1/3/2020); and the second wave (between 9/7/2020-20/10/2020).
Results
There were 19,164 admissions in 2019 and 19,131 admissions in 2020 included, with no differences in age and sex between years (mean age 73 years, 56% male). Fewer patients were provided treatment in a stroke unit in 2020 compared to 2019 (72% vs 77%, p<0.001). There were greater declines in the provision of hyperacute aspirin and secondary prevention medications at discharge in alternate wards than stroke units during the second wave (between 0.41% and 1.31% per week). Provision of mobilisation and swallow screening/assessment declined in alternate wards only. Provision of care planning at discharge improved in alternate wards relative to stroke units by 0.49% per week during the first wave and 1.14% per week during the second wave.
Conclusions
Maintaining access to stroke units is paramount to ensuring best practice care even during a pandemic.