title: Hospitals admitting at least 100 patients with stroke a year should have a stroke unit: a case study from Australia.
abstract: Establishing a stroke unit (SU) in every hospital may be infeasible because of limited resources. In Australia, it is recommended that hospitals that admit ≥100 strokes per year should have a SU. We aimed to describe differences in processes of care and outcomes among hospitals with and without SUs admitting at least 100 patients/year.
  
  
  
  National stroke audit data of 40 consecutive patients per hospital admitted between 1/7/2010-31/12/2010 and organizational survey for annual admissions were used. Descriptive analyses and multilevel regression were used to compare patient outcomes. Sensitivity analysis including only hospitals meeting all of the Australian SU criteria (e.g., co-location of beds; inter-professional team; weekly meetings; regular training) was performed.
  
  
  
  Two thousand eight hundred ninety-eight patients from 72/108 eligible hospitals completing the audit (SU = 60; patients: 2,481 [mean age 76 years; 55% male] and non-SU patients: 417 [mean age 77; 53% male]). Hospitals with SUs had greater adherence to recommended care processes than non-SU hospitals. Patients treated in a SU hospital had fewer new strokes while in hospital (OR: 0.20; 95% CI 0.06, 0.61) and there was a borderline reduction in the odds of dying in hospital compared to patients in non-SU hospitals (OR 0.57 95%CI 0.33, 1.00). Among SU hospitals meeting all SU criteria (n = 59; 91%) the adjusted odds of having a poor outcome was further reduced compared with patients attending non-SU hospitals.
  
  
  
  Hospitals annually admitting ≥100 patients with acute stroke should be prioritized for establishment of a SU that meet all recommended criteria to ensure better outcomes.
authors.affiliation: Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Clayton, 3168, Vic, Australia. dominique.cadilhac@monash.edu.|The Florey Institute of Neuroscience and Mental Health, Stroke Division, Heidelberg, 3081, Vic, Australia. dominique.cadilhac@monash.edu.
authors.forename: Dominique A
authors.initials: DA
authors.lastname: Cadilhac
authors.affiliation: Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Clayton, 3168, Vic, Australia.|The Florey Institute of Neuroscience and Mental Health, Stroke Division, Heidelberg, 3081, Vic, Australia.
authors.forename: Monique F
authors.initials: MF
authors.lastname: Kilkenny
authors.affiliation: Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Clayton, 3168, Vic, Australia.
authors.forename: Nadine E
authors.initials: NE
authors.lastname: Andrew
authors.affiliation: Stroke Foundation, Melbourne, 3000, Vic, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ritchie
authors.affiliation: Stroke Foundation, Melbourne, 3000, Vic, Australia.
authors.forename: Kelvin
authors.initials: K
authors.lastname: Hill
authors.affiliation: Stroke Foundation, Melbourne, 3000, Vic, Australia.
authors.forename: Erin
authors.initials: E
authors.lastname: Lalor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D005260:Female; D006276:Health Facility Size / Q000706:statistics & numerical data; D006295:Health Resources / Q000706:statistics & numerical data; D006757:Hospital Units / Q000458:organization & administration / Q000600:supply & distribution*; D006760:Hospitalization / Q000706:statistics & numerical data; D006761:Hospitals / Q000600:supply & distribution; D006801:Humans; D008297:Male; D020521:Stroke / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Audit; Processes of care; Stroke; Stroke unit; Thrombolysis