Hospital Overcrowding and Care of Stroke Patients. Irish National Audit of Stroke

Abstract Introduction: Hospital overcrowding where patient admissions exceed capacity is associated with worse outcomes in Emergency Department. Developments in emergency stroke care have been associated with improvements in stroke outcome but are dependent on effective, organised care. We examined if overcrowding in the hospital system was associated with negative changes in stroke outcome. Methods Data on overcrowding were obtained from the Irish Nurses and Midwives Organisation (INMO) ‘Trolley Count’ database recording the number of patients cared for on trolleys/chairs in all acute hospitals each midnight. These were compared with quarterly data from the Irish National Audit of Stroke from 2013 to 2021 inclusive. Variables analysed were inpatient mortality rate, thrombolysis rate for ischaemic stroke, median door to needle time and median length of stay. Results: 579449 patient episodes were recorded by Trolley Watch over the period, (Quarterly Median 16719.5, range 3389-27015). Average Quarterly Thrombolysis rate was 11.3% (sd 1.3%) Median Quarterly Inpatient Mortality rate was 11.8% (Range 8.9%-14.0%). Median Quarterly Length of stay was 9 days (8-11 days). Median quarterly door to needle was 65 minutes (45-80 minutes). Q1 was typically the worst for overcrowding with on average 19777 incidences (sd 4786). This was significantly higher than for Q2 (mean 13540 (sd 4785) p =0.005 t-test) and for Q3 (mean 14542 (sd 4753) p=0.03). No significant correlation was found between quarterly Trolley watch episodes and inpatient mortality (r=0.084, p=0.63), median length of stay r=-0.15, p= 0.37) or thrombolysis rate (r=0.089 p=0.61). There was an unexpected significant negative correlation between trolley watch data and median door to needle time (r=-0.36, p=0.03). Conclusion. Despite increasing hospital overcrowding, stroke services still managed to preserve standard of care. We could find no association between levels of overcrowding and deterioration in selected indices of patient care