Background: Organized stroke care units (SCU) led by multidisciplinary teams with expertise in stroke management are paramount to providing high standards of care to stroke patients. Several trials have consistently demonstrated that stroke patients admitted to a SCU are more likely to survive their stroke, regain independence and return home as compared to stroke patients admitted to general medical units. Early mobilization, improved blood pressure management, prompt intervention on complications and adherence to guidelines are some of the key components to superior outcomes of stroke patients admitted to a SCU. We describe the outcomes of stroke patients admitted to our dedicated SCU compared with stroke patients admitted to other medical units in relation to length of stay (LOS), discharge outcomes and mortality rates.
Methods: At our academic center, the SCU is comprised of stroke dedicated hospitalists, advance care providers, vascular neurologists, nursing staff specialized in stroke, physical therapists, physiatrists and care coordinators. The team conducts well designed, patient centered, daily multidisciplinary rounds focused on comprehensive treatment plans and transitions of care. The stroke dedicated hospitalist is the central player who initiates appropriate, time sensitive interventions for acute stroke management and establishes protocols for prevention, early recognition and treatment of post stroke complications such as deep vein thrombosis, aspiration pneumonia, and urinary tract infection.The stroke hospitalist works in close partnership with the vascular neurologist to align care with high quality, evidence-based guidelines such as Get with the Guidelines stroke program (American Heart Association /American Stroke Association) and performance measures implemented by the Joint Commission. We reviewed the charts of 265 stroke patients admitted to our facility from 1/1/2020 to 9/30/2020 and compared the outcomes of stroke patients admitted to our SCU to the outcomes of stroke patients admitted to other telemetry units. We compared the LOS, discharge outcomes and mortality rate among the 2 cohorts.
Results: Of the 265 patients, 151 patients were admitted to the SCU whereas 114 patients were admitted to other medical units. Average LOS ranged between 1 day and 6 days for both groups. However, a greater percentage of patients (47%) admitted to the non-SCU had a LOS greater than 7 days, compared to 31% for SCU patients. Overall, there was a reduction in LOS greater than 7 days for patients admitted to the SCU as compared to other units. Also, a higher number of of SCU patients (56.2%) were discharged home compared to 48% of non-SCU patients, which could signify an expedited clinical recovery for SCU patients.The most striking benefit was the reduction in mortality rate for stroke patients admitted to the SCU (0.66%) compared to the non-SCU patients (11.4%). Of the 265 stroke patients,14 patients died in the hospital with overall mortality rate of 5%. Of the 14 deaths reported, only 1 death occurred in the SCU, the remaining 13 patient deaths occurred in the non-stroke units.
Conclusions: Stroke patients admitted to our SCU led by a dedicated stroke team had overall improved outcomes, shorter LOS, increased discharges to home and significant reduction in mortality compared to stroke patients admitted to non-stroke units.This study highlights the pivotal role of the stroke hospitalist in developing successful strategies and delivering high quality care to stroke patients admitted to SCU.