User Experience of a Centralized Hyperacute Stroke Service

Abstract

Background and Purpose-Centralizing hyperacute stroke unit (HASU) care services allows improved access to thrombolysis but could be associated with worse patient experience, particularly when early repatriation to a local stroke recovery unit occurs as this may result in discontinuity of care. A centralized model of care was introduced in London, United Kingdom, with 8 HASUs providing acute care for the whole 8.3 million population, with repatriation on day 3 to a local stroke recovery unit. The patient and carer experience of this model of care has not been previously reported. Methods-We undertook a prospective observational study of the new model of care in the South West London sector.Patient and carer experiences were evaluated using a modified Picker Questionnaire. Separate questionnaires were used for patients discharged directly home from the HASU, those repatriated to local stroke recovery units, and for carers of patients admitted to the HASU. Results-Despite moving from a selected to nonselected admission pattern, thrombolysis rates increased from 6% to 9%.High satisfaction rates were reported among both patients and carers. Patients discharged directly home had higher satisfaction levels than those requiring repatriation to their local stroke unit, who were older and had more severe stroke. A total of 47% of carers expressed anxiety over the repatriation from the HASU back to the local stroke recovery unit, but few patients and carers reported an impact of this move on patient recovery. Conclusion-Centralized HASU care is associated with good levels of patient and carer satisfaction.

Patient experience of centralized acute stroke care pathways

“…Difficulties for families visiting hospitals a distance from their homes were discussed, in terms of time and financial costs, but patients broadly prioritized quality of care and outcomes over the issues presented by being cared for at a more distant site. This is similar to the survey findings of Moynihan et al However, consideration could be given to how best to support patients and their families in this situation. Staff flexibility over visiting times and help with travel costs were both mentioned in this study.…”

“…The NICE quality standards suggest that care should be well coordinated between different health‐care professionals. The experience of patients in this study was that care was handed over smoothly, and nobody perceived that the transfer had any adverse effect on the trajectory of their recovery, similar to the findings of Moynihan et al However, one patient described being moved from a HASU to another ward for one night, before repatriation to a local stroke unit, because of pressure on HASU beds. This highlights how capacity issues need to be carefully considered in centralized services.…”

“…Services are likely to be relatively high volume, and patient satisfaction with stroke services has been reported as lower in larger stroke services . Care may be provided in an unfamiliar environment with travelling distances increased for patients and families . Payne et al reported that travel for cancer treatment had been described as inconvenient and could be perceived as a barrier to treatment.…”

“…However, when studying angioplasty services, Sampson et al concluded that although inconvenient, people would travel further to access centralized services. A survey of the experience of patients and carers of the newly centralized stroke care pathways in London reported that the majority of stroke patients and carers were either “happy” or “did not mind” being treated in a more distant HASU, and although concern was expressed about repatriation, only 6% reported any negative effect of the transfer …”

Advances in Stroke

“…Concurrently, thrombolysis rates increased by 50%, ≤9%. 8 This study well illustrates the value of monitoring the effect on care and on stakeholders' perceptions of outcomes after implementation of such a major initiative.…”