Introduction: Stroke is the second leading cause of death in Australia. In 2012, the total financial costs of stroke in Australia were estimated to be $5 billion. Costs are estimated to be higher for regional or rural hospitals, especially those without acute stroke services. 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. 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 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.
Methods: Data from 6 months pre and post commencement of acute stroke team and stroke unit was collected retrospectively. A literature review was undertaken with search terms “stroke”, “acute stroke team”, “stroke unit” and “mortality”.
Results: We identified 152 and 160 patients pre and post commencement of services. Of 312 all strokes, 152 and 160 patients were admitted pre and post stroke unit 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-to-needle times respectively. The mean LOS reduced 50% from 8 to 4 days while in-hospital mortality dropped from 12.5% to 6.25%. Failure rate of admission swallow screen assessment improved 10-fold from 51% to 5%, although assessment data was missing in 33 pre-stroke unit patients. Cost-benefit analysis showed a $600 saving per patient.
Conclusions: Our study highlights the advantage of an acute stroke team in improving thrombolysis rates, door-to-CT and door-to-needle times, and swallow screen assessment. It reduces LOS and in-hospital mortality and results in an annual saving of $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.