Thrombolysis is not currently offered as a treatment
option for management of acute ischaemic stroke due to
organisational infrastructure limitations: lack of specialist
neurology and neurosurgical services, limited specialist
neuro-imaging capabilities, limitations to high dependency
unit facilities offered by critical care department, lack of
high dependency unit capability on current stroke unit, and
absence of core group of specialist stroke nurses/stroke liaison
nurses. Pre-hospital triage of patients with stroke by
paramedics tends to result in transport of patients who may
be eligible for thrombolysis (younger, shorter duration of
symptoms) to neighbouring centres with specialist stroke
services that do offer thrombolysis as a management option
for acute ischaemic stroke. Despite limitations to offering
thrombolysis, patients with acute stroke managed at TNH
had a number of outcomes that were superior to those
reported at national level.21 For example, in hospital mortality
rate was 8% at TNH compared with the national rate of
13%, and average length of stay for discharged patients was
5.6 days which was considerably shorter than the national
rate of 11 days.21 The proportion of patients who were independent
at discharge was 45% which was comparable to the
national rate of 49%.21