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

Abstract

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 computer-ised tomography scanning and stroke consultant assessment after the change. There were signifi cant reductions in length of stay, pneumonia and urinary tract infections at 7 days and a favourable shift in modifi ed Rankin scores (odds ratio 1.60, 95% confi dence interval 1.36-1.89, p<0.001) on discharge from hospital.