Stroke unit management in the absence of an exclusive stroke ward

Background: Several forms of stroke units improve outcome after acute ischaemic stroke. In the absence of a ward exclusively for stroke patients ("stroke ward"), intensive monitoring and management of acute stroke patients who fulfilled predefined criteria can well be performed on an intensive care unit (ICU). However, resources on intensive care unit are limited and needed mostly by others than stroke patients. Thus, intensive care unit admission criteria for stroke patients were modified to focus on high-risk patients and possible therapeutic options. Objective: To study the consequences of the modification of intensive care unit admission criteria as quality control. Methods: We performed a standardised observational comparison of clinical characteristics, medication and outcome of ICU-stroke patients prior and after modification of intensive care unit admission criteria between a one-year period in 1997/98 (initial criteria) and in 1999/2000 (modified criteria). Results: In 1999/2000, 121 out of 482 acute stroke patients (25%) were admitted on intensive care unit compared to 88 out of 323 (27%) in 1997/98. The frequency of lacunar syndromes decreased (27 to 6%; p 0.1). Conclusions: The modification of intensive care unit admission criteria was associated with (1) a higher number of ICU-stroke patients who showed a trend to a shorter intensive care unit stay, with (2) increased odds for thrombolysis and with (3) a change in case mix towards more severely affected patients. Despite the latter, the rate of patients living at home after in-hospital rehabilitation remained high. These data may illustrate that efforts to optimise stroke services are feasible and medically important.