Patient outcomes and length of stay in a stroke unit offering both acute and rehabilitation services

Abstract

Objectives: To compare hospital length of stay (LOS) and outcome after stroke between patients in a stroke unit offering combined acute and rehabilitation services and patients treated elsewhere in New South Wales. Design: Retrospective audit of two hospital databases (Diagnosis‐Related Groups [DRG] database and Australian National Subacute Non‐Acute Patient Classification System [AN‐SNAP] database), with comparison with DRG and AN‐SNAP data for NSW. Setting and participants: 242 episodes of acute stroke in patients admitted to the stroke unit of a metropolitan teaching hospital between July 1999 and November 2000, 113 of whom also underwent rehabilitation in the unit; 9777 episodes of acute stroke in the NSW DRG database, and 2350 in the NSW AN‐SNAP database. Main outcome measures: Acute and rehabilitation LOS; mortality in acute care; FIM (Functional Independence Measure) score at discharge and change in FIM score; and discharge destination. Results: Patients in the combined stroke unit had shorter LOS and better functional outcome in all DRG and AN‐SNAP groups, with both higher discharge FIM scores and greater gain in FIM scores than NSW patients. Acute stroke mortality of 12% and nursing home admission rate of 15.5% in the combined stroke unit were not significantly different from rates for NSW (15.7% and 11.2%, respectively). Conclusions: Combining acute and rehabilitation services in a stroke unit may reduce LOS and improve functional outcome of patients with acute stroke.