[Clinical benefit following the implementation of a specialized urgent stroke care system].
OBJECTIVE
Several strategies as stroke teams, stroke code teams, or stroke units development have demonstrated to improve stroke care quality. The potential benefit of implementing them as a whole has not been studied. We aimed to test the clinical efficacy of a specialized and urgent stroke assistance system in a University Hospital, as well as the specific impact of each part of the system on several clinical indicators.


METHODS
The implementation of the system followed three consecutive steps: stroke team and stroke code development, stroke unit creation and finally on-call stroke neurologists incorporation. Several clinical indicators to evaluate results have been selected. We compared data available before system onset (1992-1997) with data obtained during the system implementation (1998-2002). Modification in the results indicators following each of the individual steps of the system was also evaluated.


RESULTS
During the five years of the system implementation, 5843 stroke patients have been prospectively studied. Admission and readmission necessities were reduced up to 34.2% and 81.8% respectively. Length of stay progressively decreased from 18 (pre-1998) to 7 days (2002). In-hospital mortality and institutionalization necessities were reduced to 50.1% and 50.5% respectively. The third step, in which on-call stroke neurologist were incorporated to the system, has demonstrated to be the most efficient in decreasing the length of stay, hospital mortality and institutionalization necessities.


CONCLUSIONS
The creation of a specialized urgent stroke care system, protocol based and developed in stroke units, improves the medical assistance quality for stroke patients. Stroke neurologists on-call have a relevant role in the system working.
Alvarez-Sabín
José
J
Unidad Neurovascular, Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, Spain. josalvarez@vhebron.es
Molina
Carlos
C
Montaner
Joan
J
Arenillas
Juan
J
Pujadas
Francesc
F
Huertas
Rafael
R
Mouriño
Jorge
J
Ribó
Marc
M
Santamarina
Esteban
E
Quintana
Manuel
M
D000368:Aged; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000458:organization & administration*; D011446:Prospective Studies; D011787:Quality of Health Care; D013030:Spain; D020521:Stroke / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis