The present situation and problems of stroke care unit in our institute

We analyzed our stroke care unit (SCU), which was established 20 years ago, from the clinical and financial points of view. Our SCU has 15 beds, 22 nurses, and 30 doctors, who also work in general wards, and can afford to permit thrombolytic and hypothermic therapies. During the last 20 years, the number of patients increased gradually exceeding 500 patients/year in 1999. The increase has been accelerated since 1997 when a hot-line system with ambulance was established. The main diagnosis was acute stroke in 75% of patients, and other neurologic emergencirs was the remainders. Mean ages of patients increased by 5 years during the 20 years. The increase of elderly patients resulted in the increase of poor outcome cases and the prolongation of admission period. Since the critical-path was partially introduced in 1999, the period of hospital stay has re-duced. The financial state of our institute was analyzed 1999. The income expenditure balance in SCU was the worst among general wards and intensive care unit. The main reason for poor balance is that the costs for acute stroke diagnosis and management are rated disproportionally low in spite of a large amont of manpowers. While SCU appears to be effective to bring about better clinical outcome of stroke, its financial problems have to be solved urgently.(Jpn J Stroke 22: 546-548, 2000)