Improving care to stroke patients: adding an acute stroke unit helps.

Background: Stroke units save lives, reduce dependency, and increase the chance of returning home. A 15-bed Acute Stroke Unit (ASU) was opened on the acute hospital campus to complement an established Stroke Rehabilitation Unit (SRU) on a distant campus. The aim of this study was to address whether patient care was improved with the establishment of the ASU.

Methods: Retrospective case-note review of a sample of patients admitted with an acute stroke to Christchurch Hospital. A before and after design was utilised to audit the processes of care (PoC) using the Royal College of Physicians (London) stroke audit tool.

Results: 648 patients were admitted to the Acute Stroke Unit in the first year. The retrospective audit included 119 and 72 patients in the "before" and "after" cohorts respectively. The "after" cohort had more severe strokes (greater incontinence at one week, [p=0.03], and worse level of consciousness [p=0.008]). Length of stay, domicile on discharge, and mortality outcomes were similar for the two cohorts. Processes of care improved in the "after" cohort in 27 of the 43 domains audited.

Conclusion: Adding an ASU to complement an existing SRU can give major improvements in PoC across many different facets of stroke care. We believe this is one step closer to both the ideals of an overall coordinated stroke service and better overall care for patients with stroke.