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(Stroke. 2009;40:18.)
© 2009 American Heart Association, Inc.

Original Contributions

Impact of a Stroke Unit on Length of Hospital Stay and In-Hospital Case Fatality

Hai Feng Zhu, MD, MSc; Nancy N. Newcommon, RN, MN; Mary Elizabeth Cooper, RN, MN; Teri L. Green, RN, PhD; Barbara Seal, RN; Gary Klein, MD, FRCPC; Nicolas U. Weir, MD, MSc; Shelagh B. Coutts, MBChB, FRCPC; Tim Watson, MD, FRCPC; Philip A. Barber, MBChB, FRCPC; Andrew M. Demchuk, MD, FRCPC; Michael D. Hill, MD, MSc, FRCPC for the Calgary Stroke Program

From Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. All authors are affiliated with the Calgary Stroke Program, a partnership between the Department of Clinical Neurosciences, Calgary Health Region and the Hotchkiss Brain Institute, University of Calgary.

Correspondence to Michael D. Hill, Associate Professor, Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Rm 1242A, 1403 29^th Street NW, Calgary, Alberta, T2N 2T9, Canada. E-mail michael.hill{at}calgaryhealthregion.ca

Background and Purpose— Randomized trials have demonstrated reduced morbidity and mortality with stroke unit care; however, the effect on length of stay, and hence the economic benefit, is less well-defined. In 2001, a multidisciplinary stroke unit was opened at our institution. We observed whether a stroke unit reduces length of stay and in-hospital case fatality when compared to admission to a general neurology/medical ward.

Methods— A retrospective study of 2 cohorts in the Foothills Medical Center in Calgary was conducted using administrative databases. We compared a cohort of stroke patients managed on general neurology/medical wards before 2001, with a similar cohort of stroke patients managed on a stroke unit after 2003. The length of stay was dichotomized after being centered to 7 days and the Charlson Index was dichotomized for analysis. Multivariable logistic regression was used to compare the length of stay and case fatality in 2 cohorts, adjusted for age, gender, and patient comorbid conditions defined by the Charlson Index.

Results— Average length of stay for patients on a stroke unit (n=2461) was 15 days vs 19 days for patients managed on general neurology/medical wards (n=1567). The proportion of patients with length of stay >7 days on general neurology/medical wards was 53.8% vs 44.4% on the stroke unit (difference 9.4%; P<0.0001). The adjusted odds of a length of stay >7 days was reduced by 30% (P<0.0001) on a stroke unit compared to general neurology/medical wards. Overall in-hospital case fatality was reduced by 4.5% with stroke unit care.

Conclusions— We observed a reduced length of stay and reduced in-hospital case-fatality in a stroke unit compared to general neurology/medical wards.

Key Words: case fatality • Charlson Index • length of stay • stroke • stroke unit

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