The Acute Stroke Unit at Middlemore Hospital: an evaluation in its first year of operation.
OBJECTIVE
Despite strong evidence of benefit, few stroke units exist in New Zealand. In this paper, we describe the process and outcome for the country's first, comprehensive Acute Stroke Unit (ASU), established at Middlemore Hospital in 2001.


METHODS
The evaluation comprised: (a) two independent 'before and after' audits of medical records of a random selection of patients (2 x n=100) identified from Diagnostic Related Group (DRG) discharge codes for stroke in 1999 (12 months) and 2001-02 (9 months); (b) a review of all DRG stroke outcome data and internal cost analyses for the study periods; and (c) a 'time-in-motion' study of nursing care requirements.


RESULTS
The DRG data showed an increase in separations (538 vs 613); stable re-admissions (8% vs 7%); and declines in average length of stay (6.1 vs 5.4 days), deaths (14.0% vs 8.8%), and referrals for rehabilitation (127 vs 67); while the audit indicated shorter times from admission to brain imaging, and swallow and allied health assessments, for stroke f rom 1999 to 2001-02. A 1:4 nurse:patient ratio seems to provide an optimum level of care for costs.


CONCLUSIONS
The introduction of the ASU has been associated with improvements in several key indicators of quality of care for patients with stroke.
Di Matteo
Maria
M
Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand.
Anderson
Craig
C
Ratnasabapathy
Yogini
Y
Green
Geoff
G
Tryon
Kath
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017721:Hospital Costs; D006757:Hospital Units / Q000191:economics; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D009736:Nursing Process; D010043:Outcome and Process Assessment, Health Care; D011787:Quality of Health Care; D020521:Stroke / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D013996:Time and Motion Studies