title: Does multidisciplinary stroke care improve outcome in a secondary-level hospital in South Africa?
abstract: OBJECTIVE
  The improved outcome (survival and function) of stroke patients admitted to multidisciplinary stroke units (SU) in developed countries has not been replicated in developing countries in sub-Saharan Africa. This study documents the outcome of patients admitted to the first multidisciplinary SU opened at a secondary hospital in Cape Town, South Africa.
  
  
  METHODS
  Patient outcomes including in-hospital mortality, resource utilization (length of hospital stay, CT brain scans performed, and tertiary hospital referral), and access to inpatient rehabilitation were recorded for all patients admitted to the hospital for 3 months before initiating multidisciplinary stroke care and for 3 months after implementing multidisciplinary stroke care.
  
  
  RESULTS
  One hundred and ninety-five patients were studied; 101 of these were managed in the SU. Inpatient mortality decreased from 33% to 16% after initiating multidisciplinary stroke care (P=0.005). The length of hospital stay increased from a mean (SD, 95% CI) of 5.1 (6.5, 3.8-6.4) days to 6.8 (4.5, 5.9-7.6) days (P=0.01). Referral to inpatient rehabilitation increased from 5% to 19% (P=0.04) for those who survived to discharge. The number of CT brain scans performed and the number of referrals to the tertiary academic hospital did not increase significantly.
  
  
  CONCLUSIONS
  Multidisciplinary stroke care was successfully implemented in a resource-constrained secondary-level hospital in South Africa and despite the limitations of the study, the significant reduction in inpatient mortality and increase in referral for inpatient rehabilitation would suggest an improvement in stroke care. Resource utilization in terms of length of hospital stay increased by a mean of 2 days but the number of CT brain scans performed and referral to a tertiary hospital did not increase significantly.
authors.affiliation: Department of Medicine, Division of Geriatric Medicine, Walter and Albertina Sisulu Institute of Ageing in Africa, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa. linda.devilliers@uct.ac.za
authors.forename: Linda
authors.initials: L
authors.lastname: de Villiers
authors.forename: Sebastiana Zimba
authors.initials: SZ
authors.lastname: Kalula
authors.forename: Vanessa Celeste
authors.initials: VC
authors.lastname: Burch
mesh_terms: D005260:Female; D006757:Hospital Units / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D013019:South Africa; D020521:Stroke / Q000401:mortality* / Q000628:therapy*