Effectiveness of Acute Stroke Team in a Regional Primary Health Care Hospital

Abstract

Background and Rationale: In 2012, the total financial costs of stroke in Australia were estimated to be $5 billion (Australian Stroke Foundation). Studies have shown significant benefit of an acute stroke team in improving thrombolysis rates, reducing door-to-CT, door-to-needle and in-hospital mortality (Nazir et al.2009, Hamidon et al.2007), but this model has largely been adopted by metropolitan tertiary health care hospitals. The benefit of implementing an acute stroke service in a primary care hospital is not known. Methods: We undertook an internal audit to evaluate the effectiveness of acute stroke team in improving thrombolysis rates, door-to-CT, door-to-needle, length of stay (LOS) and mortality in a regional primary health care hospital. Data from 6 months pre and post commencement of acute stroke team and stroke unit was collected retrospectively. Results: We identified 152 and 160 patient’s pre and post commencement of services. There was a 3 fold increase in the number of stroke calls and thrombolysis rates increased from 3.7% to 12.9%. A reduction of 44 mins and 20 mins was seen in doorto-CT and door-to-needle 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 a $600 saving per patient. Conclusion: Our study highlights the advantage of an acute stroke team in improving thrombolysis rates, door-to-CT and doorto-needle times, and swallow screen assessment. It reduces LOS and in-hospital mortality and resulted in an annual saving of Fig. 1. (for Abstract 042). Asia Pacific Stroke Conference 2016 Cerebrovasc Dis 2016;42(suppl 1):1–157 DOI: 10.1159/00044773223 $96,000 in our centre. 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