Discharge disposition of patients on an acute stroke unit

Problems with patient flow through our Acute Stroke Unit prompted us to examine delays in discharging patients. We analyzed age, gender, stroke type, length of stay, discharge disposition, and cause of discharge delay for all patients with transient ischemic attack, cerebral infarction, and intracerebral hemorrhage admitted to the Acute Stroke Unit between January 1, 1994 and December 31, 1996. During this time, 729 patients were admitted; 58% were male. The median age was 71 years, and the median length of stay was 13 days (range 1 to 241 days). Seventy-five percent of the patients were admitted with cerebral infarction, 15% with transient ischemic attack, and 10% with intracerebral hemorrhage. Overall in-hospital case-fatality was 13%. Discharge was delayed in 29% of survivors. Of the survivors, 24% went home after alterations to the home environment, 62% were transferred to a rehabilitation facility, and 14% to a nursing home. Based on current figures, the cost of these delayed discharges was approximately 1.5 million Canadian dollars per year. Such "bed-blocking" necessitated admitting patients to nonneurological nursing units, which interfered with the operation of the Acute Stroke Unit. Costs could be reduced by expediting the transfer of patients when acute care is no longer needed.