Stroke: comparison of admissions in a community hospital

A retrospective comparison was made of characteristics of stroke patients admitted to 3 distinct areas of the Union-Truesdale Hospital (renamed Charlton Memorial Hospital) in Fall River, MA. The Union Division has the option for admission to an acute care stroke unit or to the medical/surgical units. The Truesdale Division is separated by 1 mile and contains medical/surgical units. The Union Division also has a rehabilitation unit for post-acute care. The 2 divisions were separate corporations with generally separate medical staffs until a merger was effected in October, 1975. Using Professional Activity Studies (PAS) reports, a cohort of 418 patients discharged between October 1, 1975, and September 30, 1976, was developed. According to ICDA-8 coding, the 3 areas of the hospital had different profiles of patients. Outcomes in terms of types of discharges were also different between 4 categories of stroke pathology. Of 57 patients referred for rehabilitation, 43 had abrupt onset with persisting focal deficit (ICDA-8 codes 433/434/436), and 14 had less clear onset with diffuse neurologic loss (ICDA-8 codes 437/438). Of the patients referred for rehabilitation, 75% were returned home after an average of 16 acute hospital days and 23 rehabilitation hospital days. This study is on a small scale and may seem to have only local relevance, but the following estimates seem to offer a reasonable probability for planning rehabilitation facilities: approximately 25% of discharges with ICDA-8 codes of 433, 434, and 436; approximately 10% of discharges with ICDA-8 codes of 437 and 438; and approximately 2% of other stroke diagnoses. Average daily hospital charges were significantly less for patients cared for in the stroke unit.