Stroke units: new study confirms benefits of longer stay

Patients with stroke who spend at least 90% of their hospital stay in a stroke unit have better outcomes, according to a recent study from the Florey, Monash Health, the Royal Melbourne Hospital, and St Vincent’s Hospital. A stroke unit is a hospital ward dedicated to treating stroke, staffed by a multidisciplinary team with ongoing education in stroke.

Evidence to support current guidelines

Tara Purvis, a PhD student at Monash Health and co-author of the study, says the benefits of stroke units are well established. ‘Patients with stroke who receive care in a stroke unit are more likely to be alive, independent and living at home one year after their stroke compared to those treated in general wards.’

National guidelines recommend that patients with stroke spend at least 90% of their hospital stay in a stroke unit. The new study is the first to provide evidence for this benchmark, linking it to reduced complications and a lower chance of being discharged to an age care facility. ‘Length of stay is also reduced,’ Ms Purvis adds. These results apply to all patients with stroke, 'regardless of age, stroke type, or severity.'

Achieving this goal for everyone

Unfortunately, not everyone in Australia receives this level of care. ‘Only 69% of patients accessed stroke unit care in the recent 2017 Acute Stroke Services Audit,’ says Ms Purvis. Patients stayed longer in the stroke unit if they were admitted within three hours of arriving in the emergency department, highlighting the need for fast transfer.

Stroke Foundation National Stroke Audit Acute Services Report 2017

There is more research to do to ensure everyone with stroke receives adequate stroke unit care. ‘Various factors can affect the time patients spend in a stroke unit, including bed capacity, bed management decisions, hospital policies, delays in the emergency department, clinical acuity or delayed discharges into the next phase of care such as rehabilitation. Further investigation into the influence of these factors, and potentially roles such as stroke care coordinators in improving patient flow through the system, would be beneficial.’

Tara Purvis is a PhD student and research officer in the division of Translational Public Health and Evaluation at Monash University.