Is length of time in a stroke unit associated with better outcomes for patients with stroke in Australia? An observational study

Research output: Contribution to journalArticleResearchpeer-review

Abstract

OBJECTIVE: 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 patient outcomes is unknown. We aimed to investigate outcomes and factors associated with patients with acute stroke spending at least 90% of their admission in an SU, compared with those having less time in the SU. DESIGN: Observational study using cross-sectional data. SETTING: Data from hospitals which participated in the 2015 Stroke Foundation National Audit: Acute Services (Australia) and had an SU. This audit includes an organisational survey and retrospective medical record audit of approximately 40 admissions from each hospital. PARTICIPANTS: Patients admitted to an SU during their acute admission were included. OUTCOME MEASURES: Hospital-based patient outcomes included length of stay, independence on discharge, severe complications and discharge destination. Patient, organisational and process indicators were included in multilevel logistic modelling to determine factors associated with spending at least 90% of their admission in an SU. RESULTS: Eighty-eight hospitals with an SU audited 2655 cases (median age 76 years, 55% male). Patients who spent at least 90% of their admission in an SU experienced: a length of stay that was 2 days shorter (coefficient -2.77, 95% CI -3.45 to -2.10), fewer severe complications (adjusted OR (aOR) 0.60, 95% CI 0.43 to 0.84) and were less often discharged to residential aged care (aOR 0.59, 95% CI 0.38 to 0.94) than those who had less time in the SU. Patients admitted to an SU within 3 hours of hospital arrival were three times more likely to spend at least 90% of their admission in an SU. CONCLUSION: Spending at least 90% of time in an SU is a valid measure of stroke care quality as it results in improved patient outcomes. Direct admission to SUs is warranted.

Original languageEnglish
Article numbere022536
Number of pages9
JournalBMJ Open
Volume8
Issue number11
DOIs
Publication statusPublished - 12 Nov 2018

Keywords

  • health services reserach
  • outcomes
  • quality in health care
  • stroke

Cite this

@article{704298e2890b41dbaf173e4f6bf0a7aa,
title = "Is length of time in a stroke unit associated with better outcomes for patients with stroke in Australia? An observational study",
abstract = "OBJECTIVE: 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 patient outcomes is unknown. We aimed to investigate outcomes and factors associated with patients with acute stroke spending at least 90{\%} of their admission in an SU, compared with those having less time in the SU. DESIGN: Observational study using cross-sectional data. SETTING: Data from hospitals which participated in the 2015 Stroke Foundation National Audit: Acute Services (Australia) and had an SU. This audit includes an organisational survey and retrospective medical record audit of approximately 40 admissions from each hospital. PARTICIPANTS: Patients admitted to an SU during their acute admission were included. OUTCOME MEASURES: Hospital-based patient outcomes included length of stay, independence on discharge, severe complications and discharge destination. Patient, organisational and process indicators were included in multilevel logistic modelling to determine factors associated with spending at least 90{\%} of their admission in an SU. RESULTS: Eighty-eight hospitals with an SU audited 2655 cases (median age 76 years, 55{\%} male). Patients who spent at least 90{\%} of their admission in an SU experienced: a length of stay that was 2 days shorter (coefficient -2.77, 95{\%} CI -3.45 to -2.10), fewer severe complications (adjusted OR (aOR) 0.60, 95{\%} CI 0.43 to 0.84) and were less often discharged to residential aged care (aOR 0.59, 95{\%} CI 0.38 to 0.94) than those who had less time in the SU. Patients admitted to an SU within 3 hours of hospital arrival were three times more likely to spend at least 90{\%} of their admission in an SU. CONCLUSION: Spending at least 90{\%} of time in an SU is a valid measure of stroke care quality as it results in improved patient outcomes. Direct admission to SUs is warranted.",
keywords = "health services reserach, outcomes, quality in health care, stroke",
author = "Doreen Busingye and Kilkenny, {Monique F.} and Tara Purvis and Joosup Kim and Sandy Middleton and Campbell, {Bruce C.V.} and Cadilhac, {Dominique A.}",
year = "2018",
month = "11",
day = "12",
doi = "10.1136/bmjopen-2018-022536",
language = "English",
volume = "8",
journal = "BMJ Open",
issn = "2044-6055",
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number = "11",

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Is length of time in a stroke unit associated with better outcomes for patients with stroke in Australia? An observational study. / Busingye, Doreen; Kilkenny, Monique F.; Purvis, Tara; Kim, Joosup; Middleton, Sandy; Campbell, Bruce C.V.; Cadilhac, Dominique A.

In: BMJ Open, Vol. 8, No. 11, e022536, 12.11.2018.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Is length of time in a stroke unit associated with better outcomes for patients with stroke in Australia? An observational study

AU - Busingye, Doreen

AU - Kilkenny, Monique F.

AU - Purvis, Tara

AU - Kim, Joosup

AU - Middleton, Sandy

AU - Campbell, Bruce C.V.

AU - Cadilhac, Dominique A.

PY - 2018/11/12

Y1 - 2018/11/12

N2 - OBJECTIVE: 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 patient outcomes is unknown. We aimed to investigate outcomes and factors associated with patients with acute stroke spending at least 90% of their admission in an SU, compared with those having less time in the SU. DESIGN: Observational study using cross-sectional data. SETTING: Data from hospitals which participated in the 2015 Stroke Foundation National Audit: Acute Services (Australia) and had an SU. This audit includes an organisational survey and retrospective medical record audit of approximately 40 admissions from each hospital. PARTICIPANTS: Patients admitted to an SU during their acute admission were included. OUTCOME MEASURES: Hospital-based patient outcomes included length of stay, independence on discharge, severe complications and discharge destination. Patient, organisational and process indicators were included in multilevel logistic modelling to determine factors associated with spending at least 90% of their admission in an SU. RESULTS: Eighty-eight hospitals with an SU audited 2655 cases (median age 76 years, 55% male). Patients who spent at least 90% of their admission in an SU experienced: a length of stay that was 2 days shorter (coefficient -2.77, 95% CI -3.45 to -2.10), fewer severe complications (adjusted OR (aOR) 0.60, 95% CI 0.43 to 0.84) and were less often discharged to residential aged care (aOR 0.59, 95% CI 0.38 to 0.94) than those who had less time in the SU. Patients admitted to an SU within 3 hours of hospital arrival were three times more likely to spend at least 90% of their admission in an SU. CONCLUSION: Spending at least 90% of time in an SU is a valid measure of stroke care quality as it results in improved patient outcomes. Direct admission to SUs is warranted.

AB - OBJECTIVE: 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 patient outcomes is unknown. We aimed to investigate outcomes and factors associated with patients with acute stroke spending at least 90% of their admission in an SU, compared with those having less time in the SU. DESIGN: Observational study using cross-sectional data. SETTING: Data from hospitals which participated in the 2015 Stroke Foundation National Audit: Acute Services (Australia) and had an SU. This audit includes an organisational survey and retrospective medical record audit of approximately 40 admissions from each hospital. PARTICIPANTS: Patients admitted to an SU during their acute admission were included. OUTCOME MEASURES: Hospital-based patient outcomes included length of stay, independence on discharge, severe complications and discharge destination. Patient, organisational and process indicators were included in multilevel logistic modelling to determine factors associated with spending at least 90% of their admission in an SU. RESULTS: Eighty-eight hospitals with an SU audited 2655 cases (median age 76 years, 55% male). Patients who spent at least 90% of their admission in an SU experienced: a length of stay that was 2 days shorter (coefficient -2.77, 95% CI -3.45 to -2.10), fewer severe complications (adjusted OR (aOR) 0.60, 95% CI 0.43 to 0.84) and were less often discharged to residential aged care (aOR 0.59, 95% CI 0.38 to 0.94) than those who had less time in the SU. Patients admitted to an SU within 3 hours of hospital arrival were three times more likely to spend at least 90% of their admission in an SU. CONCLUSION: Spending at least 90% of time in an SU is a valid measure of stroke care quality as it results in improved patient outcomes. Direct admission to SUs is warranted.

KW - health services reserach

KW - outcomes

KW - quality in health care

KW - stroke

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