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An acute stroke service: potential to improve patient outcome without increasing length of stay
D Collins1, D McConaghy, A McMahon
1Stroke Service, Adelaide and Meath Hospital, Dublin, Ireland.
Insights
Organized stroke unit care significantly reduces patient mortality and improves discharge rates. This three-year audit in an Irish hospital demonstrates the benefits of dedicated stroke services.
Area of Science:
- Neurology
- Public Health
- Healthcare Management
Background:
- Acute stroke presents a significant challenge with high morbidity and mortality rates.
- Existing meta-analyses indicate that specialized stroke unit care can mitigate these adverse outcomes.
Purpose of the Study:
- To audit the impact of the first acute stroke service in an Irish teaching hospital over a three-year period.
- To evaluate changes in patient mortality, length of stay, and discharge outcomes.
Main Methods:
- Prospective audit of 193 patients admitted to the acute stroke service from July 1996 to June 1999.
- Data collection included patient demographics, stroke type and severity, length of stay, and patient outcomes.
- Analysis focused on year-on-year trends in mortality and discharge disposition.
Main Results:
- Mortality rates decreased progressively from 19% in year 1 to 9% in year 3.
- The percentage of patients discharged home increased from 55% to 68% over the three years.
- Trends indicated an increasing patient volume, younger patient age, and improved outcomes with reduced mortality, without altering length of stay.
Conclusions:
- Organized stroke care demonstrably reduces mortality and morbidity in acute stroke patients.
- The implementation of a dedicated acute stroke service is valuable, improving patient outcomes without increasing hospital stay or disability.
- The study supports the recommendation for all acute hospitals to establish organized stroke care services.
Abstract:
Acute stroke is associated with a high morbidity and mortality: up to 24% of patients may not survive their hospital admission. Stroke unit care has been shown in a meta-analysis to reduce this morbidity and mortality. We present a three-year audit of the first acute stroke service in an Irish teaching hospital. The audit was carried out prospectively on 193 patients admitted to the acute stroke service, from July 1996 to end of June 1999. Details regarding patients, type and severity of stroke, length of stay and outcome were collected prospectively on a standard pro-forma. We observed a reduction in mortality from 19% to 15% to 9%, and an increasing percentage of patients discharged home from 55% to 64% to 68%, in year 1, year 2 and year 3 respectively. A trend towards a greater number of patients, younger age and improved outcome with lower mortality was observed from year to year, without significant change in length of stay. This study confirms the value to patients of organised stroke care in terms of reduction in mortality and morbidity without increasing length of stay or disability. We suggest that every acute hospital should have organised stroke care.