Length of time in a stroke unit is associated with better outcomes for patients with stroke in Australia.

Abstract

Background and Rationale: Spending at least 90% of hospital admission in a stroke unit (SU) is a recommended indicator of receiving high quality stroke care. However, whether this makes a difference to outcomes is unknown. We aimed to investigate outcomes and factors associated with patients with acute stroke spending at least 90% of their admission in a SU, compared to those having less time in the SU. Method(s): Data from 112 hospitals that participated in the 2015 Stroke Foundation Acute Services Program in Australia were used. This included a survey of organisational resources and a retrospective medical record audit of up to 40 admissions from each hospital. Univariable and multilevel multivariable regression analyses were undertaken. Result(s): Data from 2655 patients (median age 76 years and 55% male) were available. Patients who spent at least 90% of their admission in a SU experienced: a length of stay that was two days shorter (coefficient -2.77 95%CI -3.45, -2.10), fewer severe complications (aOR: 0.60; 95% CI: 0.43, 0.84) and were less often discharged to residential aged care (aOR: 0.59; 95% CI: 0.38, 0.94) than those who had less time in the SU. Patients admitted to a SU within three hours of arrival to the hospital were three times more likely to spend at least 90% of their admission in a SU. Conclusion(s): Spending at least 90% of time in a SU is an excellent measure of stroke care quality as it results in improved patient outcomes. Direct admissions to stroke units is warranted.