The Acute Stroke Unit at Middlemore Hospital: an evaluation in its first year of operation

Aim Despite strong evidence of benefit, few stroke units exist in New Zealand. In this paper, we describe the process and outcome for the country’s first, comprehensive Acute Stroke Unit (ASU), established at Middlemore Hospital in 2001. Methods The evaluation comprised: (a) two independent ‘before and after’ audits of medical records of a random selection of patients (2 x n=100) identified from Diagnostic Related Group (DRG) discharge codes for stroke in 1999 (12 months) and 2001–02 (9 months); (b) a review of all DRG stroke outcome data and internal cost analyses for the study periods; and (c) a ‘time-in-motion’ study of nursing care requirements. Results The DRG data showed an increase in separations (538 vs 613); stable readmissions (8% vs 7%); and declines in average length of stay (6.1 vs 5.4 days), deaths (14.0% vs 8.8%), and referrals for rehabilitation (127 vs 67); while the audit indicated shorter times from admission to brain imaging, and swallow and allied health assessments, for stroke from 1999 to 2001–02. A 1:4 nurse:patient ratio seems to provide an optimum level of care for costs. Conclusions The introduction of the ASU has been associated with improvements in several key indicators of quality of care for patients with stroke. Specialised Acute Stroke Units (ASUs) have been shown to improve the use of health care resources and the chances of patients surviving free of dependency and/or institutional care after stroke. 1 Moreover, the benefits appear consistent across major patient subgroups: such as the young and old; those with mild, moderate, or severe grades of disability; and in those admitted either early or late after onset. Several distinct features of ASUs that appear important are better coordination of multidisciplinary team (MDT) rehabilitation, integration of nurses and carers in the rehabilitation process, staff with an interest and special skills in stroke care, and the education and training of staff, patients, and carers. 2 However, despite the strong