Organised care of acute stroke at Groote Schuur Hospital : a controlled trial

Includes bibliographical references.Background and purpose: Groote Schuur Hospital (GSH) admits about 570 stroke patients annually. These patients about occupy 10% of acute medical beds. Recent investigations have demonstrated that stroke services are poorly organised Although "Organised stroke care" has been shown to improve outcomes, this has not been demonstrated locally. This study was undertaken to determine whether stroke unit care within a general medical ward improves outcomes. Study design and sampling: The study was a prospective non-randomised controlled trial, with systematic allocation by admission day. of all acute stroke admissions to the Department of Medicine from 1 January to 15 May 1996. Intervention: There were three comparison groups: in the Stroke Intervention Ward, the intervention was implemented by the author; in the Guidelines Ward, the manner in which the intervention can be set up and implemented was provided in the form of a Guidelines Booklet and in the Control Ward, stroke patients received routine care. The intervention consisted of (i) geographic/spatial unity and allocation of a designated nurse; (ii) use of a Stroke Clerking Pro forma and (iii) a multidisciplinary Team Care Plan and Post Intake Stroke Ward Round. Results: 58 patients were admitted to the Stroke Intervention Ward, 40 patients were admitted to the Guidelines Ward and 91 were admitted to the 2 Control Wards. The groups had similar baseline characteristics, except for the percentage of patients continent on admission. There were no significant differences in the Modified Barthel Index prior to admission, at discharge or at follow-up. There were no significant differences in the principal outcome measures (death, dependency, death or dependency, institutionalisation and death or institutionalisation) between the comparison groups. The median [inter-quartile range] length of hospital stay in days was significantly reduced in the Stroke Intervention Ward (6.5[5-9]) compared to the Guidelines Ward (9[7-14]) and the Control Wards (8[5-12]). The referral rates to Professionals Allied to Medicine were significantly increased in the Stroke Intervention Ward, except for referrals to the Community Liaison Sister. The referral rates to rehabilitation resources on discharge were significantly increased in the Stroke Intervention Ward, except for referrals to physiotherapy. Conclusions: Organised Stroke Care is feasible in our setting and results in improved utilisation of resources without increasing length of stay. However, principle outcome measures were not significantly altered in this study