Impact of a stroke unit on length of hospital stay and in-hospital case fatality

Zhu, Hai Feng, Newcommon, Nancy N., Cooper, Mary Elizabeth, Green, Teri L., Seal, Barbara, Klein, Gary, Weir, Nicolas U., Coutts, Shelagh B., Watson, Tim, Barber, Philip A., Demchuk, Andrew M., & Hill, Michael D. (2008) Impact of a stroke unit on length of hospital stay and in-hospital case fatality. Stroke, 40(1), pp. 18-23.

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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 (n=2461) was 15 days vs 19 days for patients managed on general neurology/medical wards (n=1567). The proportion of patients with length of stay >7 days on general neurology/medical wards was 53.8% vs 44.4% on the stroke unit (difference 9.4%; P<0.0001). The adjusted odds of a length of stay >7 days was reduced by 30% (P<0.0001) 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.

Impact and interest:

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ID Code: 85192
Item Type: Journal Article
Refereed: Yes
Keywords: case fatality, Charlson Index, length of stay, stroke, stroke unit
DOI: 10.1161/STROKEAHA.108.527606
ISSN: 1524-4628
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NURSING (111000) > Nursing not elsewhere classified (111099)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Nursing
Deposited On: 08 Jul 2015 23:51
Last Modified: 16 Jul 2015 02:40

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