title: Improved stroke care processes and outcomes following the institution of an acute stroke unit at a New Zealand district general hospital.
abstract: OBJECTIVE
  To examine whether stroke care processes and outcomes are improved following the institution of an acute stroke unit (ASU) at a medium-sized New Zealand hospital.
  
  
  METHODS
  Two retrospective audits over 12-month periods were carried out at Hutt Valley Hospital before and after the institution of a 6-bed ASU. Data was collected on demographics, length of stay, stroke type, investigations, processes of care and outcomes.
  
  
  RESULTS
  139 strokes pre ASU and 155 strokes post ASU were studied. 86.8% of strokes received stroke unit care in the 2009 audit. There were more intracerebral haemorrhages in 2006 (17.2% vs. 9.0%). Significant improvements were seen between 2006 and 2009 in time to aspirin administration (52.7 versus 14.5 hours), swallow assessment within 24 hours (88.5% versus 96.1%), lag time to carotid Doppler studies (21 days versus 4.5 days), pressure risk assessments (19.6%, versus 87.2%) and urinary infection rates (10.8% versus 2.0% ). Total length of stay (TLOS) and mortality were reduced but the difference was not statistically significant. (20.5 days versus 18.3 days p=0.34, Inpatient mortality 16.2% versus 10% p=0.12).
  
  
  CONCLUSIONS
  The introduction of an ASU has resulted in improvements in several key processes of stroke care. Overall mortality and total length of stay showed a trend to improvement after the establishment of an ASU.
authors.affiliation: General Medical Unit, Hutt Valley Hospital, Lower Hutt, New Zealand.
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Burgess
authors.forename: Ritva
authors.initials: R
authors.lastname: Vyas
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hudson
authors.forename: Olivia
authors.initials: O
authors.lastname: Browne
authors.forename: Yun C
authors.initials: YC
authors.lastname: Lee
authors.forename: Sisira
authors.initials: S
authors.lastname: Jayathissa
authors.forename: Tom
authors.initials: T
authors.lastname: Thomson
mesh_terms: D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003422:Critical Care / Q000458:organization & administration; D005260:Female; D017052:Hospital Mortality; D006757:Hospital Units / Q000458:organization & administration*; D006769:Hospitals, General; D006801:Humans; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D009520:New Zealand; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D016019:Survival Analysis