Differences in stroke care practices between regional and metropolitan hospitals

Background: A recent audit of stroke care in major Australian metropolitan teaching hospitals showed considerable variation in care practices and uptake of evidence-based therapies. We could find no published data on stroke care practices in regional Australia. Aim: To compare acute stroke care practices at four regional hospitals with a metropolitan teaching hospital with a stroke unit. Methods: The hospital medical records of 30 consecutive patients at each hospital (total 150 patients), with a discharge diagnosis of stroke, were retrospectively audited to identify differences in stroke care practices, including the use of investigations, acute interventions, and secondary prevention strategies, between the regional and metropolitan, and between smaller (less than 150 stroke admissions annually) and larger (more than 250 admissions annually) hospitals. Results: Patients treated at regional or smaller hospitals were less likely to have a computed tomography head scan within 24 h of admission, carotid duplex, echocardiography, estimations of lipids and glucose, a swallow assessment, involvement of allied health professionals or be prescribed prophylaxis against deep vein thrombosis, compared to patients treated at metropolitan or larger hospitals. Conclusions: Significant differences in stroke care practices exist between regional/smaller and metropolitan/ larger hospitals. Strategies designed to minimize variation in care practices, such as evidence-based care pathways, should be explored.