Acute stroke in South Ayrshire: comparative study of pre and post stroke units

In September 1993 arrangements for managing acute stroke victims in South Ayrshire changed with the opening of a six bedded Acute Stroke Unit and a fifteen bedded Rehabilitation Stroke Unit. Previously all such patients were managed within general medical wards with a few being managed in geriatric assessment and rehabilitation facilities. This study compares the management and outcome from acute stroke before and after the establishment of these new Units. Fifty-eight patients' medical, nursing and paramedical records were studied for the period of investigation in 1992 and 68 for the same period in 1993. There was no significant difference in the age of the patients admitted or in the degree of neurological or functional impairment at the time of admission. There was a reduction in mortality from 37.9% in 1992 to 22.0% in 1993. This was not accomplished by an increase in the number of survivors requiring long term institutional care and there was no significant difference in the degree neurological or functional impairment at the time of discharge. A variety of specific management issues were also addressed by the study and in all areas there were improvements in the quality of care received by this group of patients in 1993. This study supports the view that management of acute stroke victims in specifically designated Stroke Units has a beneficial effect on outcome and quality of care.