In diagnosing and treating stroke, time is of the essence…but what if the hospital won’t admit you?

By Katie Warner, an expert medical negligence lawyer at Irwin Mitchell 

Every year in the UK more than 100,000 people are diagnosed as having a stroke. It's the fourth most common cause of death in the UK.

Stroke Services in the UK

It's widely accepted that receiving specialist treatment in the first 72 hours of having a stroke is vital for patients to survive and survive well. 

Sadly, restricted availability of scanning facilities and sufficiently specialist staff has resulted in some hospitals limiting their stroke services so that they don't accept patients overnight. 

The risk to patient safety in these circumstances is underscored by the following incident that was the subject of an investigation by the Healthcare Safety Investigation Branch (HSIB).

Tragic consequences of shortcomings in care

HSIB has made recommendations following review of an incident involving delays in a 75-year-old man accessing treatment following a stroke.  The full report can be accessed here.

As part of its investigation HSIB found:

• Delays in the ambulance attending
• Confusion about which hospital the patient should be transferred to
• Trusts not accepting Patient X because of overnight closures and time since onset of symptoms
• Delays in Patient X being admitted to the emergency department upon arrival at hospital

Following admission, a CT scan confirmed that Patient X had suffered an ischaemic stroke - a stroke caused by a blood clot in the brain.  He was taken to intensive care and a tracheostomy was performed to help him breathe.  

He remained in intensive care for two weeks and was then transferred to a stroke unit. Unfortunately his condition deteriorated and after two-and-a-half months, Patient X died.

Learning Lessons

The HSIB investigation found that there was no clear agreement within the local area, between the Trusts, regarding arrangements for the admission of FAST-positive patients overnight. 

In the absence of what appears to be a coherent pathway, Patient X’s diagnosis and treatment was delayed. During this period of delay he was experiencing stroke symptoms, which one could only imagine were likely to have been frightening as well as debilitating, with no specialist assistance.  

In the aftermath, it's possible that he and his family were left to contemplate the ‘what if’ questions that could have followed. 

Reconfiguration of Service

This incident highlights ongoing difficulties in accessing stroke services.  In recent years many Trusts across the UK have reconfigured stroke services, with smaller units closing and the creation of hyper acute stroke units (HASU). 

Critics of the re-organisation point to patients facing life-threatening situations because they have to travel further to access care. 

Those advocating change, including the Stroke Association, point to examples like the above case and argue that the benefit of being able to access specialist care, 24 hours per day, seven days a week, more than offsets the additional distance to be travelled.

Conclusion

The HSIB report states that the CCG for Trust A and Trust B has announced that it would be establishing a HASU at Trust B.  The hope has to be that patients in the future will have 24/7 access and that Patient X’s experience will not be repeated.

Find out more about Irwin Mitchell's expertise in supporting patients and families affected by care delays at our dedicated medical negligence section.