Impact of a Stroke Unit on Length of Hospital Stay and In-Hospital Case Fatality

Abstract

Background and Purpose-Randomized trials have demonstrated reduced morbidity and mortality with stroke unit care; however, the effect on length of stay, and hence the economic benefit, is less well-defined. In 2001, a multidisciplinary stroke unit was opened at our institution. We observed whether a stroke unit reduces length of stay and in-hospital case fatality when compared to admission to a general neurology/medical ward. Methods-A retrospective study of 2 cohorts in the Foothills Medical Center in Calgary was conducted using administrative databases. We compared a cohort of stroke patients managed on general neurology/medical wards before 2001, with a similar cohort of stroke patients managed on a stroke unit after 2003. The length of stay was dichotomized after being centered to 7 days and the Charlson Index was dichotomized for analysis. Multivariable logistic regression was used to compare the length of stay and case fatality in 2 cohorts, adjusted for age, gender, and patient comorbid conditions defined by the Charlson Index. Results-Average length of stay for patients on a stroke unit (nϭ2461) was 15 days vs 19 days for patients managed on general neurology/medical wards (nϭ1567). The proportion of patients with length of stay Ͼ7 days on general neurology/medical wards was 53.8% vs 44.4% on the stroke unit (difference 9.4%; PϽ0.0001). The adjusted odds of a length of stay Ͼ7 days was reduced by 30% (PϽ0.0001) on a stroke unit compared to general neurology/medical wards. Overall in-hospital case fatality was reduced by 4.5% with stroke unit care. Conclusions-We observed a reduced length of stay and reduced in-hospital case-fatality in a stroke unit compared to general neurology/medical wards. (Stroke. 2009;40:18-23.)

Length of stay and medical stability for spinal cord-injured patients on admission to an inpatient rehabilitation hospital: a comparison between a model SCI trauma center and non-SCI trauma center

“…13 Zhu et al 14 found that the adjusted odds of an LOS more than 7 days were reduced by 30% on a stroke unit compared with general neurology/medical wards. Similarly, the presence of in-house core trauma surgeons and physician assistants improved management and outcome (including reduced LOS) of critically injured trauma patients within a level I TC.…”

Stroke Unit Care Is Beneficial Both for the Patient and for the Health Service and Should Be Widely Implemented

“…Research that will facilitate implementation is very welcome and should have a high priority. The article published in this issue of Stroke by Zhu et al 11 is an important contribution in this regard. The authors have explored the effects of implementation of SU care in the Calgary Health Region in Canada.…”

Diagnosis and management of acute ischemic stroke: speed is critical

“…Randomized controlled trials have shown conclusively that patients treated in dedicated stroke units fare better than those treated in general wards without the same ready access to personnel trained and experienced in managing stroke. [56][57][58][59] The spectrum of stroke syndrome in these studies included both ischemic and hemorrhagic stroke, ranging from mild (transient ischemic attack and minor stroke) to more severe. 58 In one trial, providing treatment in a stroke unit significantly reduced in-hospital mortality (odds ratio Patients with stroke who receive organized inpatient care in a stroke unit are more likely to be alive, independent and living at home one year after the stroke.…”

“…[56][57][58][59] The spectrum of stroke syndrome in these studies included both ischemic and hemorrhagic stroke, ranging from mild (transient ischemic attack and minor stroke) to more severe. 58 In one trial, providing treatment in a stroke unit significantly reduced in-hospital mortality (odds ratio Patients with stroke who receive organized inpatient care in a stroke unit are more likely to be alive, independent and living at home one year after the stroke. 57,60,61 These benefits were most apparent in units based in a discrete ward, and there is substantial evidence of avoidance of direct costs when such care is implemented.…”