Stressed systems: Stroke unit bed occupancy and impact on reperfusion therapy in acute ischemic stroke

Abstract

ObjectivesWe observed a decrease in the number of patients who were offered reperfusion therapy. We aimed to investigate if whether hospital system pressure measured as the percentage of stroke bed occupancy influenced decisions on treatment and disposition.DesignData from a regional quality of stroke care database were obtained and linked to the organizational data monitoring of the hourly inpatient stroke bed occupancy rate. Logistic regression was used to analyze the relationship.ResultsA total of 15,025 admissions were included from 1 January 2019 to 24 August 2022. Of these, 5,659 (38%) had an acute ischemic stroke. The rates of reperfusion therapy treatment were the highest in 2019 (36.2%) and 2020 (34.1%) and declined afterward (30.0% in 2021). In the logistic regression analysis, an occupancy rate of ≥85% in the hour of the first admission was associated with reduced odds of admission at the stroke unit within 3 h from the symptom onset [adjusted odds ratio: 0.80, 95% confidence interval: (0.71–0.90), p < 0.001] and a reduced odds of receiving reperfusion therapy (adjusted odds ratio: 0.83 (0.73–0.95), p = 0.007).ConclusionAn increased bed occupancy level in the hour of the first hospital admission for stroke patients was strongly associated with decreased odds of receiving reperfusion therapy.

Improving multidisciplinary hospital care for acute cerebral circulation disorders in Kazakhstan

“…A comparative analysis of the outcomes of stroke patients in urban and rural hospitals in Australia found that patients admitted to rural hospitals were less likely to receive thrombolysis compared to urban hospitals (7.5% in rural hospitals vs. 12.7% in urban hospitals, p < 0.001), while it was also noted that fewer patients were discharged with a planned care appointment (61.3% in urban areas compared to 44.7% in rural areas, p < 0.001) [ 15 ]. Besides, in the current research, it has been established that the raised level of bed occupancy in the first hour of hospitalization of patients with a stroke is closely connected with a reduction in the chances of receiving reperfusion therapy [ 16 ].…”