Stroke patients prefer care in specialist units
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《英国医生杂志》
Patients who have had a stroke are more satisfied with their care if they are looked after on specialist wards rather than general wards. This is the finding of a survey of patients' experience of their care in hospitals in England published this week.
The survey of 1713 patients (mean age 75 years) admitted to hospitals in England between April and June 2004 with a primary diagnosis of intracerebral haemorrhage, cerebral infarction, or stroke showed that most were positive about the treatment they received in hospital, with 69% of patients rating their care as excellent or very good.
Only a quarter of patients were initially admitted to a stroke unit, however, and a third (36%) of the patients had been cared for on general wards for most of their hospital stay, despite evidence showing that care on specialist wards results in better survival and recovery rates.
This was seen in the survey results. For example, more than half (56%) of those who stayed in a stroke unit said that they had enough help with speech and communication problems compared with 38% of patients who stayed in other types of ward.
A higher proportion (16%) of patients who stayed in a non-specialist ward considered that they did not get help to improve their mobility, compared with patients who stayed in specialist stroke units (5%).
A substantial proportion of patients reported they had not always received the help that they needed with getting to the toilet on time (34%), eating meals (42%), or washing (33%) while in hospital. One in 10 patients who had difficulty swallowing said that they did not receive help in hospital when they needed it. However, higher proportions of those who stayed in specialist stroke units reported that they received help with these activities compared with patients who stayed in other types of wards.
More patients who stayed in hospital in a stroke unit had confidence and trust in the doctors (83%) and nursing staff (79%) who treated them, compared with those who stayed on other types of ward (70% for both).
After leaving hospital, 63% of patients said that all the services they needed, such as occupational therapy, were arranged for them. However, 15% of those who needed such services reported that these were not arranged for them at all. Again, people who had stayed on stroke units were more satisfied with rehabilitation services that they were offered after leaving hospital.
The survey, which had a response rate of 65%, showed that patients were keen to take part in decisions about their care. Just over half of the patients surveyed said that they would like to be more involved in decisions about their care and treatment in hospital, but that this was not always achieved. A large percentage (62%) said that they were not told about potential side effects of medicines, and 21% said that the purpose of the medication was not explained to them at all.
Nearly two thirds (63%) of respondents felt that doctors always answered their questions in a way that they could understand, but 10% said that doctors often talked in front of them as if they were not there.
Jonathan Boyce, head of external outputs with the Healthcare Commission, an organisation that reviews the NHS and which did the survey, said, "One of the most important findings is that patients cared for on stroke units are more satisfied with their care."(Susan Mayor)
The survey of 1713 patients (mean age 75 years) admitted to hospitals in England between April and June 2004 with a primary diagnosis of intracerebral haemorrhage, cerebral infarction, or stroke showed that most were positive about the treatment they received in hospital, with 69% of patients rating their care as excellent or very good.
Only a quarter of patients were initially admitted to a stroke unit, however, and a third (36%) of the patients had been cared for on general wards for most of their hospital stay, despite evidence showing that care on specialist wards results in better survival and recovery rates.
This was seen in the survey results. For example, more than half (56%) of those who stayed in a stroke unit said that they had enough help with speech and communication problems compared with 38% of patients who stayed in other types of ward.
A higher proportion (16%) of patients who stayed in a non-specialist ward considered that they did not get help to improve their mobility, compared with patients who stayed in specialist stroke units (5%).
A substantial proportion of patients reported they had not always received the help that they needed with getting to the toilet on time (34%), eating meals (42%), or washing (33%) while in hospital. One in 10 patients who had difficulty swallowing said that they did not receive help in hospital when they needed it. However, higher proportions of those who stayed in specialist stroke units reported that they received help with these activities compared with patients who stayed in other types of wards.
More patients who stayed in hospital in a stroke unit had confidence and trust in the doctors (83%) and nursing staff (79%) who treated them, compared with those who stayed on other types of ward (70% for both).
After leaving hospital, 63% of patients said that all the services they needed, such as occupational therapy, were arranged for them. However, 15% of those who needed such services reported that these were not arranged for them at all. Again, people who had stayed on stroke units were more satisfied with rehabilitation services that they were offered after leaving hospital.
The survey, which had a response rate of 65%, showed that patients were keen to take part in decisions about their care. Just over half of the patients surveyed said that they would like to be more involved in decisions about their care and treatment in hospital, but that this was not always achieved. A large percentage (62%) said that they were not told about potential side effects of medicines, and 21% said that the purpose of the medication was not explained to them at all.
Nearly two thirds (63%) of respondents felt that doctors always answered their questions in a way that they could understand, but 10% said that doctors often talked in front of them as if they were not there.
Jonathan Boyce, head of external outputs with the Healthcare Commission, an organisation that reviews the NHS and which did the survey, said, "One of the most important findings is that patients cared for on stroke units are more satisfied with their care."(Susan Mayor)