Evaluation of a single centre stroke service reconfiguration – the impact of transition from a combined (acute and rehabilitation) stroke unit to a hyperacute model of stroke care | Zendy

Dipankar Dutta | Zendy; Kate Hellier | Zendy; Mudhar Obaid | Zendy; Arnold Deering | Zendy

Open Access

Evaluation of a single centre stroke service reconfiguration – the impact of transition from a combined (acute and rehabilitation) stroke unit to a hyperacute model of stroke care

Author(s) -

Dipankar Dutta,

Kate Hellier,

Mudhar Obaid,

Arnold Deering

Publication year - 2017

Publication title -

future healthcare journal

Language(s) - English

Resource type - Journals

eISSN - 2514-6653

pISSN - 2514-6645

DOI - 10.7861/futurehosp.4-2-99

Subject(s) - stroke (engine) , medicine , rehabilitation , confidence interval , odds ratio , acute stroke , audit , emergency medicine , physical therapy , nursing , emergency department , mechanical engineering , engineering , management , economics

We reorganised the combined (acute and rehab) stroke unit (SU) at Gloucestershire Royal Hospital into a hyperacute stroke unit (HASU) and a rehab SU where patients are moved after spending about 72 hours on HASU. Continuous monitoring of physiological variables was introduced and consultant job plans were reorganised to provide a HASU physician of the week model with enhanced 7-day senior presence along with redistribution of junior medical staff. Sentinel Stroke National Audit Programme (SSNAP) data for 14 months preceding the reorganisation (n=1,049) and 14 months after (n=974) were accessed for outcomes. More patients were admitted directly to the HASU with favourable reductions in time to computerised tomography scanning and stroke consultant assessment after the change. There were significant reductions in length of stay, pneumonia and urinary tract infections at 7 days and a favourable shift in modified Rankin scores (odds ratio 1.60, 95% confidence interval 1.36-1.89, p<0.001) on discharge from hospital.

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