Hospitals admitting at least 100 patients with stroke a year should have a stroke unit: a case study from Australia

Dominique A. Cadilhac, Monique F. Kilkenny, Nadine Andrew, Elizabeth A Ritchie, Kelvin Hill, Erin Lalor

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Establishing a stroke unit (SU) in every hospital may be infeasible because of limited resources. In Australia, it is recommended that hospitals that admit ≥100 strokes per year should have a SU. We aimed to describe differences in processes of care and outcomes among hospitals with and without SUs admitting at least 100 patients/year. Methods: National stroke audit data of 40 consecutive patients per hospital admitted between 1/7/2010-31/12/2010 and organizational survey for annual admissions were used. Descriptive analyses and multilevel regression were used to compare patient outcomes. Sensitivity analysis including only hospitals meeting all of the Australian SU criteria (e.g., co-location of beds; inter-professional team; weekly meetings; regular training) was performed. Results: Two thousand eight hundred ninety-eight patients from 72/108 eligible hospitals completing the audit (SU = 60; patients: 2,481 [mean age 76 years; 55% male] and non-SU patients: 417 [mean age 77; 53% male]). Hospitals with SUs had greater adherence to recommended care processes than non-SU hospitals. Patients treated in a SU hospital had fewer new strokes while in hospital (OR: 0.20; 95% CI 0.06, 0.61) and there was a borderline reduction in the odds of dying in hospital compared to patients in non-SU hospitals (OR 0.57 95%CI 0.33, 1.00). Among SU hospitals meeting all SU criteria (n = 59; 91%) the adjusted odds of having a poor outcome was further reduced compared with patients attending non-SU hospitals. Conclusion: Hospitals annually admitting ≥100 patients with acute stroke should be prioritized for establishment of a SU that meet all recommended criteria to ensure better outcomes.

Original languageEnglish
Article number212
Number of pages9
JournalBMC Health Services Research
Volume17
Issue number1
DOIs
Publication statusPublished - 16 Mar 2017

Keywords

  • Audit
  • Processes of care
  • Stroke
  • Stroke unit
  • Thrombolysis

Cite this

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title = "Hospitals admitting at least 100 patients with stroke a year should have a stroke unit: a case study from Australia",
abstract = "Background: Establishing a stroke unit (SU) in every hospital may be infeasible because of limited resources. In Australia, it is recommended that hospitals that admit ≥100 strokes per year should have a SU. We aimed to describe differences in processes of care and outcomes among hospitals with and without SUs admitting at least 100 patients/year. Methods: National stroke audit data of 40 consecutive patients per hospital admitted between 1/7/2010-31/12/2010 and organizational survey for annual admissions were used. Descriptive analyses and multilevel regression were used to compare patient outcomes. Sensitivity analysis including only hospitals meeting all of the Australian SU criteria (e.g., co-location of beds; inter-professional team; weekly meetings; regular training) was performed. Results: Two thousand eight hundred ninety-eight patients from 72/108 eligible hospitals completing the audit (SU = 60; patients: 2,481 [mean age 76 years; 55{\%} male] and non-SU patients: 417 [mean age 77; 53{\%} male]). Hospitals with SUs had greater adherence to recommended care processes than non-SU hospitals. Patients treated in a SU hospital had fewer new strokes while in hospital (OR: 0.20; 95{\%} CI 0.06, 0.61) and there was a borderline reduction in the odds of dying in hospital compared to patients in non-SU hospitals (OR 0.57 95{\%}CI 0.33, 1.00). Among SU hospitals meeting all SU criteria (n = 59; 91{\%}) the adjusted odds of having a poor outcome was further reduced compared with patients attending non-SU hospitals. Conclusion: Hospitals annually admitting ≥100 patients with acute stroke should be prioritized for establishment of a SU that meet all recommended criteria to ensure better outcomes.",
keywords = "Audit, Processes of care, Stroke, Stroke unit, Thrombolysis",
author = "Cadilhac, {Dominique A.} and Kilkenny, {Monique F.} and Nadine Andrew and Ritchie, {Elizabeth A} and Kelvin Hill and Erin Lalor",
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Hospitals admitting at least 100 patients with stroke a year should have a stroke unit : a case study from Australia. / Cadilhac, Dominique A.; Kilkenny, Monique F.; Andrew, Nadine; Ritchie, Elizabeth A; Hill, Kelvin; Lalor, Erin.

In: BMC Health Services Research, Vol. 17, No. 1, 212, 16.03.2017.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Hospitals admitting at least 100 patients with stroke a year should have a stroke unit

T2 - a case study from Australia

AU - Cadilhac, Dominique A.

AU - Kilkenny, Monique F.

AU - Andrew, Nadine

AU - Ritchie, Elizabeth A

AU - Hill, Kelvin

AU - Lalor, Erin

PY - 2017/3/16

Y1 - 2017/3/16

N2 - Background: Establishing a stroke unit (SU) in every hospital may be infeasible because of limited resources. In Australia, it is recommended that hospitals that admit ≥100 strokes per year should have a SU. We aimed to describe differences in processes of care and outcomes among hospitals with and without SUs admitting at least 100 patients/year. Methods: National stroke audit data of 40 consecutive patients per hospital admitted between 1/7/2010-31/12/2010 and organizational survey for annual admissions were used. Descriptive analyses and multilevel regression were used to compare patient outcomes. Sensitivity analysis including only hospitals meeting all of the Australian SU criteria (e.g., co-location of beds; inter-professional team; weekly meetings; regular training) was performed. Results: Two thousand eight hundred ninety-eight patients from 72/108 eligible hospitals completing the audit (SU = 60; patients: 2,481 [mean age 76 years; 55% male] and non-SU patients: 417 [mean age 77; 53% male]). Hospitals with SUs had greater adherence to recommended care processes than non-SU hospitals. Patients treated in a SU hospital had fewer new strokes while in hospital (OR: 0.20; 95% CI 0.06, 0.61) and there was a borderline reduction in the odds of dying in hospital compared to patients in non-SU hospitals (OR 0.57 95%CI 0.33, 1.00). Among SU hospitals meeting all SU criteria (n = 59; 91%) the adjusted odds of having a poor outcome was further reduced compared with patients attending non-SU hospitals. Conclusion: Hospitals annually admitting ≥100 patients with acute stroke should be prioritized for establishment of a SU that meet all recommended criteria to ensure better outcomes.

AB - Background: Establishing a stroke unit (SU) in every hospital may be infeasible because of limited resources. In Australia, it is recommended that hospitals that admit ≥100 strokes per year should have a SU. We aimed to describe differences in processes of care and outcomes among hospitals with and without SUs admitting at least 100 patients/year. Methods: National stroke audit data of 40 consecutive patients per hospital admitted between 1/7/2010-31/12/2010 and organizational survey for annual admissions were used. Descriptive analyses and multilevel regression were used to compare patient outcomes. Sensitivity analysis including only hospitals meeting all of the Australian SU criteria (e.g., co-location of beds; inter-professional team; weekly meetings; regular training) was performed. Results: Two thousand eight hundred ninety-eight patients from 72/108 eligible hospitals completing the audit (SU = 60; patients: 2,481 [mean age 76 years; 55% male] and non-SU patients: 417 [mean age 77; 53% male]). Hospitals with SUs had greater adherence to recommended care processes than non-SU hospitals. Patients treated in a SU hospital had fewer new strokes while in hospital (OR: 0.20; 95% CI 0.06, 0.61) and there was a borderline reduction in the odds of dying in hospital compared to patients in non-SU hospitals (OR 0.57 95%CI 0.33, 1.00). Among SU hospitals meeting all SU criteria (n = 59; 91%) the adjusted odds of having a poor outcome was further reduced compared with patients attending non-SU hospitals. Conclusion: Hospitals annually admitting ≥100 patients with acute stroke should be prioritized for establishment of a SU that meet all recommended criteria to ensure better outcomes.

KW - Audit

KW - Processes of care

KW - Stroke

KW - Stroke unit

KW - Thrombolysis

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U2 - 10.1186/s12913-017-2150-2

DO - 10.1186/s12913-017-2150-2

M3 - Article

VL - 17

JO - BMC Health Services Research

JF - BMC Health Services Research

SN - 1472-6963

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M1 - 212

ER -