Time well spent in stroke units


By Mardi Chapman

27 Nov 2018

About two thirds (64%) of stroke patients in Australia spend at least 90% of their admission in a stroke unit – a valid measure of stroke care quality resulting in improved patient outcomes.

According to an analysis of national data from more than 4,000 patients across 112 hospitals, patients who spend at least 90% of their admission in a stroke unit have a shorter length of hospital stay, fewer severe complications and are less likely to be discharged to residential aged care.

The study found in-hospital complications such as aspiration pneumonia and other infections, falls, stroke progression and seizures were less common in people who spent at least 90% of their admission in a stroke unit.

It found there was also evidence of a dose effect between the occurrence of any severe complications and the percentage of admission spent in a stroke unit (SU).

“Importantly, patients who spent at least 90% of their admission in an SU compared with those who did not, were more likely to be admitted to an SU within 3 hours of arrival to ED, have a brain scan within 24 hours, be discharged from the hospital on the same day they were discharged from the SU, be assessed for rehabilitation by a physiotherapist within 48 hours of admission and have rehabilitation therapy commenced within 48 hours of their initial assessment,” the study authors said.

Professor Dominique Cadilhac, head of Translational Public Health and Evaluation at Monash University, told the limbic numerous trials and systematic reviews have demonstrated that management in a stroke unit was associated with better patient outcomes.

“But what we didn’t have evidence for was how long people need to be in the unit to benefit, and what we noticed was that the UK has started using this indicator of quality – for people to benefit they need to spend at least 90% of their admission in a stroke unit – and we wanted to test whether that has any merit because that wasn’t necessarily based on any literature that we could find.”

She said there was certainly room to improve access to stroke units in Australia.

“We need to continue to prioritise access to stroke units because still we find that a large proportion of our patients aren’t even getting any access.”

“Hospitals need to consider the volume of patients they receive every year, any access issues into those units, and whether or not they have sufficient beds to provide at least the majority of those patients’ stays in the stroke unit to get maximal benefit.”

“Nationally, we definitely need to improve on that and there are equity issues in regional areas. People are at a greater disadvantage in regional areas or where they are not going to their major regional hospital hub.”

In response, a stroke telemedicine program has been implemented in Victoria providing 24-hour access to a stroke neurologist to help local hospitals with a differential diagnosis and treatment decisions, said Professor Cadilhac.

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