Establishment of a stroke unit in a district hospital: review of experience

Background: The experience and outcomes of co-locating acute stroke and stroke rehabilitation care in a district hospital were reviewed. Method: Information for patients admitted to Blacktown and Mt Druitt Hospitals before and after setting up an acute stroke unit (SU) (12 months data for each period), including mortality and length of stay (LOS) at the hospital were obtained from various sources, including the diagnosis-related group and subacute and non-acute casemix databases. Results: There was a significant reduction of mortality (18 vs 10%; P = 0.01) and reduced total LOS (46 vs 39 days; P = 0.01) with similar functional outcomes in the post-SU period. Fifty per cent of patients were unable to access the acute SU. Patients admitted into the SU had lower mortality (5 vs 14%; P = 0.01) and were also discharged from hospital earlier (35 vs 54 days; P = 0.01) than patients admitted into general wards during the post-SU period. Thirty-four per cent of patients received rehabilitation within the rehabilitation facility in the post-SU period compared with 19% in the pre-SU period. Conclusion: The Blacktown experience showed the feasibility of establishing a co-located SU within rehabilitation facility with good outcomes as illustrated by the significant reduction in the stroke mortality, a reduction in the total LOS and an increase in the number of patients receiving rehabilitation post-stroke.