Care of acute stroke patients in general hospitals in Israel

An important question on the health agenda concerns the most appropriate place to hospitalize stroke patients and its effect on acute stroke care.

To examine how the existing hospital system treats these patients, specifically: a) the departments to which stroke patients are admitted; b) differences in the admission, diagnosis and rehabilitative care of stroke patients, by department,' c) patient characteristics, by department; and d) mortality rates during hospitalization.

We surveyed 616 people with acute stroke (ICD-CM9 430-433, 436) admitted consecutively to one of seven large general hospitals in Israel between October 1998 and January 1999. Data were collected from medical records at admission and at discharge.

Forty-two percent of the patients were admitted to an internal medicine department, 56% to a neurology department, and only 2% to a geriatric department. The majority (95%) underwent a computed tomography scan of the brain, but other imaging tests were performed on fewer patients, with significant differences among hospitals and between internal medicine and neurology departments. Patients admitted to neurology departments were younger and had milder stroke symptoms than did patients admitted to internal medicine departments. Fifty-three percent of patients received at least one type of rehabilitative care during their hospital stay--usually physiotherapy, and least often occupational therapy. Seventeen percent of stroke patients died during hospitalization. Mortality was not found to be related to the admitting department.

Uniform realistic policies and work procedures should be formulated for all hospitals in Israel regarding the admitting department and processes as well as the performance of diagnostic imaging. Standards of medical and rehabilitative care and discharge destination should be developed to promote quality of care while containing utilization and costs.