title: User experience of a centralized hyperacute stroke service: a prospective evaluation.
abstract: OBJECTIVE
  Centralizing hyperacute stroke unit (HASU) care services allows improved access to thrombolysis but could be associated with worse patient experience, particularly when early repatriation to a local stroke recovery unit occurs as this may result in discontinuity of care. A centralized model of care was introduced in London, United Kingdom, with 8 HASUs providing acute care for the whole 8.3 million population, with repatriation on day 3 to a local stroke recovery unit. The patient and carer experience of this model of care has not been previously reported.
  
  
  METHODS
  We undertook a prospective observational study of the new model of care in the South West London sector. Patient and carer experiences were evaluated using a modified Picker Questionnaire. Separate questionnaires were used for patients discharged directly home from the HASU, those repatriated to local stroke recovery units, and for carers of patients admitted to the HASU.
  
  
  RESULTS
  Despite moving from a selected to nonselected admission pattern, thrombolysis rates increased from 6% to 9%. High satisfaction rates were reported among both patients and carers. Patients discharged directly home had higher satisfaction levels than those requiring repatriation to their local stroke unit, who were older and had more severe stroke. A total of 47% of carers expressed anxiety over the repatriation from the HASU back to the local stroke recovery unit, but few patients and carers reported an impact of this move on patient recovery.
  
  
  CONCLUSIONS
  Centralized HASU care is associated with good levels of patient and carer satisfaction.
authors.affiliation: From the Stroke and Dementia Research Centre, St George's University of London, London, United Kingdom.
authors.forename: Barry
authors.initials: B
authors.lastname: Moynihan
authors.forename: Selina
authors.initials: S
authors.lastname: Paul
authors.forename: Hugh S
authors.initials: HS
authors.lastname: Markus
mesh_terms: D003695:Delivery of Health Care / Q000379:methods / Q000458:organization & administration; D019538:Health Care Surveys; D007902:Length of Stay; D008131:London; D010343:Patient Admission / Q000592:standards*; D017060:Patient Satisfaction; D020521:Stroke / Q000628:therapy*; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy / Q000379:methods / Q000592:standards*; D006113:United Kingdom
keywords: diagnosis; health services research; quality of health care; stroke; thrombolytic therapy