• Stroke · Jan 2009

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

    • Hai Feng Zhu, Nancy N Newcommon, Mary Elizabeth Cooper, Teri L Green, Barbara Seal, Gary Klein, Nicolas U Weir, Shelagh B Coutts, Tim Watson, Philip A Barber, Andrew M Demchuk, Michael D Hill, and Calgary Stroke Program.
    • Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Rm 1242A, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada.
    • Stroke. 2009 Jan 1;40(1):18-23.

    Background And PurposeRandomized 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.MethodsA 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.ResultsAverage 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.ConclusionsWe observed a reduced length of stay and reduced in-hospital case-fatality in a stroke unit compared to general neurology/medical wards.

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