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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. | Austin Authors: | Cadilhac, Dominique A;Kilkenny, Monique F;Andrew, Nadine E;Ritchie, Elizabeth;Hill, Kelvin;Lalor, Erin | Affiliation: | Stroke Foundation, Melbourne, 3000, Victoria, Australia Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Clayton, 3168, Victoria, Australia |
Issue Date: | 16-Mar-2017 | Date: | 2017-03-16 | Publication information: | BMC health services research 2017; 17(1): 212 | Abstract: | 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. 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. 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. 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. | URI: | https://ahro.austin.org.au/austinjspui/handle/1/19058 | DOI: | 10.1186/s12913-017-2150-2 | ORCID: | 0000-0001-8162-682X 0000-0002-3375-287X |
Journal: | BMC health services research | PubMed URL: | 28302181 | Type: | Journal Article | Subjects: | Audit Processes of care Stroke Stroke unit Thrombolysis |
Appears in Collections: | Journal articles |
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