STANDARDS FOR THE HOSPITAL MANAGEMENT OF STROKE PATIENTS

To examine the extent to which current guidelines for the hospital man agement of stroke are being met, a series of 15 specific standards cov ering initial assessment and management, rehabilitation, discharge and secondary prevention was developed from the guidelines suggested by t he Ring's Fund and the Royal College of Physicians. This article descr ibes these standards, their interobserver reliability and their use in practice. The interobserver agreement on the application of most stan dards was good (80% or more). A survey of 100 consecutive patients wit h stroke showed that certain standards were well met (adequate social history, routine investigation, prevention of pressure sores and monit oring of blood pressure), whereas others were poorly met (diagnosis, r apid referral to therapists, functional reassessment, liaison with gen eral practitioners, documentation of multidisciplinary rehabilitation programmes, and communication with patients and relatives). Several st andards, especially those central to the rehabilitation process, were met significantly more frequently in patients managed by geriatricians than in those managed by general physicians. This may be attributable to geographical concentration of patients and to rehabilitation led b y consultants trained in stroke management. It is suggested that these standards are verifiable measures which can be used more widely to au dit the process of care.