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. Patients with stroke have better outcomes if they are admitted to a stroke unit (SU); 1–3 they have greater chance of being alive and independent and less likely to require long term institutional care at one year. 1 Guidelines for the management of stroke advocate for the establishment of stroke units as well as organised stroke services throughout New Zealand. 4 Christchurch Hospital is the acute hospital for Christchurch and surrounding North Canterbury and serves a catchment population of approximately 450,000 people. 5 It is a university teaching hospital and has the regional neurosurgical unit. Approximately 800 people are admitted each year with a diagnosis of an acute stroke. In Christchurch, a stroke rehabilitation unit (SRU) for older patients was opened in 2001 with documented benefits both for patients and the District Health Board (DHB). 6,7 The Christchurch SRU was always envisaged as being one part of a larger integrated stroke service, with an acute stroke unit (ASU) and a community based specialist rehabilitation team planned from the outset. 8