Evaluation of stroke management in an Irish university teaching hospital: The Royal College of Physicians stroke audit package

Background. There are few data regarding the standard of stroke care in Ireland. Aim. To investigate the level of documentation for 13 key areas of stroke management. Methods. Using a validated stroke audit package, this study reviewed the medical records of 100 consecutive patients hospitalised with acute stroke. Results. Documentation of stroke symptoms, risk factors, general examination and investigations (cranial computer tomography [CT] and carotid Dopplers) were satisfactory. Neurological documentation was variable, with power (87%), sensation (70%) and eye movements (63%) being the most frequently recorded features, while cognition (3%), visual fields (13%), gait (7%), incontinence (1%) and swallowing (0%) were infrequently recorded. Diagnostic formulation and an acute management plan were documented in less than half of patients, whereas cranial CT (93%) and carotid Dopplers (93%) were well documented. Secondary preventive measures were documented in two-thirds of patients at follow-up. Conclusions. These results serve as a baseline from which to initiate and monitor improvements in the service at our hospital, including the involvement of neurologists in stroke care, and will also allow assessment of the impact of such changes.