THE NEW ZEALAND MEDICAL JOURNAL        NZMJ 7 November 2008, Vol 121 No 1285; ISSN 1175 8716 Page 46 URL: http://www.nzma.org.nz/journal/121-1285/3343/ ©NZMA Acute stroke services in New Zealand: changes between 2001 and 2007 P Alan Barber, John Gommans, John Fink, H Carl Hanger, Patricia Bennett, Nina Ataman Abstract Aim To determine changes in the organisation of acute stroke management in New Zealand between 2001 and 2007. Method A questionnaire was sent to 58 New Zealand hospitals; it included questions about access to organised stroke care, the presence of designated areas for stroke patient management, guidelines for stroke management, and audit. Results Responses were received from all hospitals surveyed, with 46 admitting stroke patients either acutely or for stroke rehabilitation. Sixteen District Health Boards (DHBs) covering 88% of the population have a physician who provides overall leadership for stroke services. Seven of 46 hospitals, covering 48% of the population, had areas designated for acute management of stroke patients. Rehabilitation for patients older than 65 years was carried out in designated areas for patients with stroke in seven hospitals, covering 49% of the population. Only 13 hospitals (serving 60% of the population) had audited local inpatient stroke care at the patient level and 10 (45% of the population) at the service level. Conclusion While there have been improvements in the development of an organised approach to acute inpatient acute stroke care in New Zealand there remain major variations between different centres. The training of general physicians, geriatricians, and neurologists in stroke medicine must be seen as a priority. Since the early to mid 1990s, overwhelming evidence shows that stroke unit care significantly reduces death and disability after stroke compared with care in general wards. 1 However in New Zealand-wide surveys performed in 2001 and 2002, only one large urban and four medium-sized regional hospitals out of 41 had stroke units, and only one hospital had a dedicated stroke rehabilitation unit. 2,3 Since this time, New Zealand and international stroke guidelines have clearly stated that all patients admitted to hospital with stroke should expect to be managed in a stroke unit and that the provision of organised stroke care should be seen as a priority. 4,5 We have repeated the surveys with the aim of obtaining an overall picture of the provision of stroke services throughout New Zealand and to determine whether or not this has improved in recent years. This report concentrates on the acute management of stroke with the results from the rehabilitation components of the survey published separately. 6 Methods We updated and combined the questionnaires used in the original surveys of acute stroke services (2001) and stroke rehabilitation services (2002). 2,3 This questionnaire was sent to the medical director or a physician known to have an interest in stroke at each of 58 hospitals thought to admit patients with stroke. These hospitals were identified from a New Zealand hospital directory and covered the whole of the country. The hospitals were divided into three groups according to the population served; large (urban hospitals serving populations