Effectiveness of acute stroke team in a primary health care hospital

Abstract

Introduction: Studies have shown significant benefit of an acute stroke team (AST) in improving thrombolysis rates, reducing door-to-CT, door-toneedle and in-hospital mortality, but this model is largely adapted by metropolitan tertiary health care hospitals. The benefit of implementing acute stroke service in a primary care hospital is not known. Aim: We undertook an internal audit to evaluate the effectiveness of AST in improving thrombolysis rates, door-to-CT, door-to-needle, length of stay (LOS) and mortality in a primary health care hospital. Methods: Data from 6 months pre and post commencement of AST and stroke unit was collected retrospectively. Results: We identified 152 and 160 patients pre and post commencement of services respectively. There was a 3 fold increase in the number of stroke calls and thrombolysis rates increased from 7.6% to 12.9%. A reduction of 44mins and 20mins was seen in door-to-CT and door-toneedle times respectively. The mean LOS reduced from 8 to 4 days while in-hospital mortality dropped from 12.5% to 6.25%. Failure rate of admission swallow screening improved from 51% to 5%. Cost-benefit analysis showed $600 saving per patient. Conclusions: Our study highlights the advantage of an AST in improving thrombolysis rates, time to treatment, and swallow screening. It reduces LOS and in-hospital mortality and results in an annual saving of has a $96,000. We plan to expand our service after hours and perform a larger prospective study to confirm our findings with the long-term aim of providing service to a wider catchment area. Show more