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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
  1. Doreen Busingye1,
  2. Monique F Kilkenny1,2,
  3. Tara Purvis1,
  4. Joosup Kim1,2,
  5. Sandy Middleton3,
  6. Bruce C V Campbell4,
  7. Dominique A Cadilhac1,2
  1. 1 Translational Public Health and Evaluation Division, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
  2. 2 Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
  3. 3 Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, Darlinghurst, New South Wales, Australia
  4. 4 Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
  1. Correspondence to Dr Dominique A Cadilhac; dominique.cadilhac{at}monash.edu

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.

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

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Footnotes

  • Contributors DB, MFK and DAC were responsible for study concept and design. DB, TP, JK and MFK were responsible for statistical analyses. DB drafted the manuscript. DB, MFK, TP, JK, SM, BCVC and DAC interpreted the data, critically revised the manuscript for important intellectual context and approved the final version for submission. DB, MFK, TP, JK, SM, BCVC and DAC agreed to be accountable for all aspects of the work.

  • Funding The following authors receive research fellowship support from the NHMRC: DAC (1063761-cofunded Heart Foundation), MFK (Early Carer Fellowship 1109426).

  • Competing interests BCVC and SM are members of the Stroke Foundation Clinical Council.

  • Patient consent Not required.

  • Ethics approval Ethics approval was granted through Monash University Human Research Ethics Committee (CF16/825-2016000402).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Contact can be made with the corresponding author for queries relating to unpublished data.

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