title: Impact of a stroke unit on length of hospital stay and in-hospital case fatality.
abstract: OBJECTIVE
  Randomized trials have demonstrated reduced morbidity and mortality with stroke unit care; however, the effect on length of stay, and hence the economic benefit, is less well-defined. In 2001, a multidisciplinary stroke unit was opened at our institution. We observed whether a stroke unit reduces length of stay and in-hospital case fatality when compared to admission to a general neurology/medical ward.
  
  
  METHODS
  A retrospective study of 2 cohorts in the Foothills Medical Center in Calgary was conducted using administrative databases. We compared a cohort of stroke patients managed on general neurology/medical wards before 2001, with a similar cohort of stroke patients managed on a stroke unit after 2003. The length of stay was dichotomized after being centered to 7 days and the Charlson Index was dichotomized for analysis. Multivariable logistic regression was used to compare the length of stay and case fatality in 2 cohorts, adjusted for age, gender, and patient comorbid conditions defined by the Charlson Index.
  
  
  RESULTS
  Average length of stay for patients on a stroke unit (n=2461) was 15 days vs 19 days for patients managed on general neurology/medical wards (n=1567). The proportion of patients with length of stay >7 days on general neurology/medical wards was 53.8% vs 44.4% on the stroke unit (difference 9.4%; P<0.0001). The adjusted odds of a length of stay >7 days was reduced by 30% (P<0.0001) on a stroke unit compared to general neurology/medical wards. Overall in-hospital case fatality was reduced by 4.5% with stroke unit care.
  
  
  CONCLUSIONS
  We observed a reduced length of stay and reduced in-hospital case-fatality in a stroke unit compared to general neurology/medical wards.
authors.affiliation: Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Rm 1242A, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada.
authors.forename: Hai Feng
authors.initials: HF
authors.lastname: Zhu
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Newcommon
authors.forename: Mary Elizabeth
authors.initials: ME
authors.lastname: Cooper
authors.forename: Teri L
authors.initials: TL
authors.lastname: Green
authors.forename: Barbara
authors.initials: B
authors.lastname: Seal
authors.forename: Gary
authors.initials: G
authors.lastname: Klein
authors.forename: Nicolas U
authors.initials: NU
authors.lastname: Weir
authors.forename: Shelagh B
authors.initials: SB
authors.lastname: Coutts
authors.forename: Tim
authors.initials: T
authors.lastname: Watson
authors.forename: Philip A
authors.initials: PA
authors.lastname: Barber
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D015331:Cohort Studies; D015897:Comorbidity; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data* / Q000639:trends*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009313:National Health Programs / Q000706:statistics & numerical data / Q000639:trends; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D017678:Sex Distribution; D020521:Stroke / Q000401:mortality* / Q000451:nursing / Q000628:therapy*; D016896:Treatment Outcome