How do comprehensive and acute stroke units differ? A critical review

Abstract

Background: Stroke unit care is advocated for all acute stroke patients. Varying models of stroke unit care exist and there is a need to identify how these models differ and how these differences may affect patient outcomes. This review explores the difference between the comprehensive stroke unit model, which includes rehabilitation, and the acute stroke unit model, which does not. Content: A review of descriptive information regarding comprehensive and acute stroke units was performed to determine the differences in the underlying components of care. Conclusion: A greater emphasis on acute medical care appears to exist in the acute stroke unit, with higher levels of nurse staffing, earlier assessment and investigation, more intensive physiological monitoring and an increased use of thrombolysis and anti-platelet therapy. In contrast, the availability of a period of rehabilitation in the comprehensive stroke unit appears to create a greater emphasis on rehabilitation, even in the acute phase, with greater involvement of gerontologists, rehabilitation physicians and allied health professionals, increased multidisciplinary staff education and training, greater patient and carer participation in rehabilitation, and early mobilisation protocols.

Early Physical Activity and Discharge Destination after Stroke: A Comparison of Acute and Comprehensive Stroke Unit Care

“…This finding is consistent with what would be expected in a rehabilitation model of care. These results support our recent review of ASU and CSU care, in which we found that the ASU model tends to focus primarily on acute medical care, while a stronger emphasis on multidisciplinary rehabilitation appears to exist in the CSU model even in the acute stage of stroke [10]. The greater emphasis on multidisciplinary rehabilitation in the CSU may promote the increased early physical activity found in the current study.…”

Guidelines for Adult Stroke Rehabilitation and Recovery

“…53 Age, cognition, functional level after stroke, and to a lesser extent continence have shown consistent associations with poststroke outcomes, and stroke severity is associated with acute discharge disposition, final discharge disposition, and functional level. 54 In recent years, lengths of stay in IRFs have decreased significantly, but in survivors with mild to moderate stroke, patient satisfaction does not appear to be diminished, and recovery actually may be faster.…”

Physical Activity Patterns of Acute Stroke Patients Managed in a Rehabilitation Focused Stroke Unit

“…Early physical activity has been described as a key component of the CSU model of care [4, 13]. In a review of the literature describing the ASU and CSU models of care we found an emphasis on acute medical management, increased nurse staffing, early assessment and investigation, and intensive physiological monitoring in ASU care models [14]. In contrast, CSU care tended to have a greater emphasis on multidisciplinary teamwork and involvement in rehabilitation, active participation of the patient and family, and early mobilisation policies [14].…”

“…In a review of the literature describing the ASU and CSU models of care we found an emphasis on acute medical management, increased nurse staffing, early assessment and investigation, and intensive physiological monitoring in ASU care models [14]. In contrast, CSU care tended to have a greater emphasis on multidisciplinary teamwork and involvement in rehabilitation, active participation of the patient and family, and early mobilisation policies [14]. These underlying features of the CSU may facilitate increased physical activity early after stroke compared to alternative models of acute stroke care.…”