Stroke Unit- / Stroke Center-Management

2021 ◽  
Vol 78 (6) ◽  
pp. 328-338
Author(s):  
Joachim Fladt ◽  
Stefan Engelter ◽  
Gian Marco De Marchis ◽  
Marios Psychogios ◽  
Philippe Lyrer ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Stroke Units ◽  
Stroke Center ◽  
Prävention Und Therapie

Zusammenfassung. In der Schweiz erleiden etwa 16’000 Menschen pro Jahr einen Hirnschlag. Für deren Behandlung stehen derzeit 23 Stroke Units und Stroke Center zur Verfügung. Die Akutbehandlung auf einer Stroke Unit folgt einem standardisierten, ganzheitlichen und interdisziplinären Ansatz, dessen Kernaufgaben die Prävention und Therapie von Akutkomplikationen, die Ursachenabklärung und Rezidivprophylaxe sowie die Frührehabilitation und Sozialplanung umfassen. Die Stroke Unit-Behandlung senkt die Mortalität und das Risiko bleibender Beeinträchtigungen nach einem Hirnschlag und ist neben der intravenösen Thrombolyse und der mechanischen Thrombektomie der Grundpfeiler der Hirnschlag-Akutbehandlung. Der folgende Artikel liefert einen detaillierten Überblick über die Kernaufgaben und aktuellen Behandlungsstandards des Stroke Unit-Managements.

Abstract TP391: Transition to a Single Dedicated Stroke Unit Improves Patient Satisfaction

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Patty Noah ◽  
Chris Hackett ◽  
Melanie Henderson ◽  
Leslie Pope ◽  
Vicki Cohen ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Stroke Unit ◽  
Stroke Units ◽  
Assessment Scores ◽  
Care Assessment ◽  
The Press ◽  
Before And After ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
One Year

Introduction: Dedicated inpatient stroke units have been shown to decrease mortality and improve clinical outcomes. There is scant data on patient satisfaction within dedicated stroke units or the perception of care reported by the patient. At a single comprehensive stroke center we recently consolidated two stroke units on different physical locations to a single dedicated stroke unit, located in close proximity to the neuro ICU. We assessed patient satisfaction before and after transitioning to a single dedicated stroke unit. Methods: We analyzed the Press Ganey survey overall satisfaction scores for one year preceding and one year following transition to a single dedicated stroke unit. The overall satisfaction score is rated on a likert scale from 0 - 100. We also analyzed subsection of the Press Ganey survey. An independent samples T-test statistical analysis was used to compare the data. Results: The unified stroke unit was opened on January 1, 2018. We evaluated 177 Press Ganey surveys in the year preceding the transition and 191 surveys in the year following the transition to a single dedicated stroke unit. The overall patient satisfaction was significantly higher in the year after transitioning to single dedicated stroke unit (mean 91.3, SD = 15.7) than in the year prior (mean 87.6, SD = 19.7), [ 95%CI 0.06 - 7.34], p = 0.05. Additionally, after moving the dedicated stroke unit patient care assessment scores in the stroke unit increased and variance decreased (mean 95.5, SD = 8.4) compared to the year prior (mean 85.1, SD = 25.4), although this difference was not statistically significant, p = 0.28. Conclusions: We found that transitioning to a single dedicated stroke unit significantly improved patient satisfaction scores and provided patients with more consistent care.

scholarly journals COVID-19: Stroke Admissions, Emergency Department Visits, and Prevention Clinic Referrals

2020 ◽  
Vol 47 (5) ◽  
pp. 693-696 ◽  
Author(s):  
Maria Bres Bullrich ◽  
Sebastian Fridman ◽  
Jennifer L. Mandzia ◽  
Lauren M. Mai ◽  
Alexander Khaw ◽  
...  
Keyword(s):  
Emergency Department ◽  
Stroke Prevention ◽  
Stroke Unit ◽  
Emergency Department Visits ◽  
Related Factors ◽  
Hospital Policies ◽  
The Government ◽  
Stroke Center ◽  
The Impact ◽  
Prevention Clinic

Abstract:We assessed the impact of the coronavirus disease 19 (COVID-19) pandemic on code stroke activations in the emergency department, stroke unit admissions, and referrals to the stroke prevention clinic at London’s regional stroke center, serving a population of 1.8 million in Ontario, Canada. We found a 20% drop in the number of code strokes in 2020 compared to 2019, immediately after the first cases of COVID-19 were officially confirmed. There were no changes in the number of stroke admissions and there was a 22% decrease in the number of clinic referrals, only after the provincial lockdown. Our findings suggest that the decrease in code strokes was mainly driven by patient-related factors such as fear to be exposed to the SARS-CoV-2, while the reduction in clinic referrals was largely explained by hospital policies and the Government lockdown.

Abstract 5: Management Of Intravenous tPA In Non-ICU Environments: Safety, Clinical Outcome, And Cost Savings

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Kisha C Coleman ◽  
Paola Palazzo ◽  
Reza B Shahripour ◽  
Amy L Brooks ◽  
Mary A Cronin ◽  
...  
Keyword(s):  
Critical Care ◽  
Stroke Unit ◽  
Cost Savings ◽  
Pressure Control ◽  
Cardiac Monitoring ◽  
Arterial Line ◽  
Systemic Hemodynamic ◽  
Stroke Units ◽  
Critical Care Admission ◽  
Iv Tpa

Background: Administration of IV tPA has traditionally necessitated admission to an ICU solely for monitoring, with relatively no need for extensive critical care services. Stroke Units that are capable of monitoring IV tPA patients have been proposed to reduce ICU use, but limited data exist that demonstrate safety. We report the largest series of non-ICU managed tPA cases in relation to safety and discharge outcomes. Methods: Consecutive cases admitted to our intermediate-level Stroke Unit spanning 2009-2011 were assembled. Unit capabilities include IV tPA management with nicardipine infusion for blood pressure control as needed, non-invasive or direct central/arterial line and cardiac monitoring, and BiPAP ventilation. Stroke Unit nurses underwent extensive orientation and participate in NET SMART Junior for continuing education. Overall sICH, and drip/ship sICH (parenchymal hemorrhage in combination with > 4 point increase on the NIHSS), systemic hemorrhage, and tPA related death rates were calculated, along with discharge mRS and total ICU cost savings per day. Results: A total of 302 Stroke Unit admissions for intravenous tPA occurred over the 3 year period, while another 31 (10%) were excluded due to critical care admission for systemic hemodynamic or pulmonary instability. Nicardipine infusions were used in 9 (10.5%) Stroke Unit tPA cases in 2009, 10 (9%) in 2010, and 14 (13%) in 2011. Overall sICH rate was 3.3% (n=10) and systemic hemorrhage rate was 2.9% (n=9) with 5 of these (56%) requiring transfusion. Estimated cost savings in total for this 3 year period was $362,400 for “avoided” ICU days. Conclusions: Intravenous tPA patients may be safely managed on non-ICU Stroke Units when nurses undergo extensive education to ensure clinical competence. Use of the ICU solely for management of tPA monitoring needs may constitute significant overuse of system resources at an expense that is not associated with additional safety benefit.

Stroke Rehabilitation 2007: What Should it Be?

2007 ◽  
Vol 2 (3) ◽  
pp. 191-200 ◽  
Author(s):  
Helen M. Dewey ◽  
Lisa J. Sherry ◽  
Janice M. Collier
Keyword(s):  
Stroke Unit ◽  
Stroke Rehabilitation ◽  
Number Needed To Treat ◽  
Stroke Patients ◽  
High Quality ◽  
High Quality Research ◽  
Stroke Units ◽  
Proven Efficacy ◽  
Stroke Unit Care ◽  
Medical Wards

Background There are an estimated 62 million stroke survivors worldwide. The majority will have long-term disability. Despite this reality, there have been few large, high-quality randomized controlled trials of stroke rehabilitation interventions. Summary of review There is excellent evidence for the effectiveness of a number of stroke rehabilitation interventions, notably care of stroke patients in inpatient stroke units and stroke rehabilitation units providing organized, goal-focused care via a multidisciplinary team. Stroke units (in comparison with care on general medical wards) effectively reduce death and disability with the number needed to treat to prevent one person from failing to regain independence being 20. Unfortunately, only a minority of stroke patients have access to stroke unit care. The key principles of effective stroke rehabilitation have been identified. These include ( 1 ) a functional approach targeted at specific activities e.g. walking, activities of daily living, ( 2 ) frequent and intense practice, and ( 3 ) commencement in the first days or weeks after stroke. Conclusion The most effective approaches to restoration of brain function after stroke remain unknown and there is an urgent need for more high-quality research. In the meantime, simple, broadly applicable stroke rehabilitation interventions with proven efficacy, particularly stroke unit care, must be applied more widely.

scholarly journals European Stroke Organisation certification of stroke units and stroke centres

2018 ◽  
Vol 3 (3) ◽  
pp. 220-226 ◽  
Author(s):  
Ulrike Waje-Andreassen ◽  
Darius G Nabavi ◽  
Stefan T Engelter ◽  
Diederik WJ Dippel ◽  
Damian Jenkinson ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Stroke Care ◽  
Evidence Base ◽  
Final Decision ◽  
Major Step ◽  
High Quality ◽  
Stroke Units ◽  
Stroke Treatment ◽  
Research Activities ◽  
Stroke Centre

To improve quality and to overcome the wide discrepancies in stroke care both within- and between European countries, the European Stroke Organisation Executive Committee initiated in 2007 activities to establish certification processes for stroke units and stroke centres. The rapidly expanding evidence base in stroke care provided the mandate for the European Stroke Organisation Stroke Unit-Committee to develop certification procedures for stroke units and stroke centres with the goals of setting standards for stroke treatment in Europe, improving quality and minimising variation. The purpose of this article is to present the certification criteria and the auditing process for stroke units and stroke centres that aim to standardise and harmonise care for stroke patients, and hence become members of the European Stroke Organisation Stroke Unit and Stroke Centre network. Standardised application forms and guidelines for national and international auditors have been developed and updated by members of the European Stroke Organisation Stroke Unit-Committee. Key features are availability of trained personnel, diagnostic equipment, acute treatment and collaboration with other stroke-caregivers. After submission, the application is reviewed by one national and two international auditors. Based on their reports, the Stroke Unit-Committee will make a final decision. Validating on-site visits for a subset of stroke units and stroke centres are planned. We herein describe a novel, European Stroke Organisation-based online certification process of stroke units and stroke centres. This is a major step forward towards high-quality stroke care across Europe. The additional value by connecting high-quality European Stroke Organisation Stroke Unit and Stroke Centre is facilitation of future collaboration and research activities, enabling building and maintenance of a high-quality stroke care network in Europe.

scholarly journals A register-based study comparing planned rehabilitation following acute stroke in 2011 and 2017

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Malin C. Nylén ◽  
Hanna C. Persson ◽  
Tamar Abzhandadze ◽  
Katharina S. Sunnerhagen
Keyword(s):  
Stroke Unit ◽  
Community Hospital ◽  
Binary Logistic Regression ◽  
University Hospital ◽  
Impaired Consciousness ◽  
University Hospitals ◽  
Cross Sectional ◽  
Severe Stroke ◽  
Stroke Units ◽  
Explanatory Variables

AbstractThis cross-sectional, register-based study aimed to explore patterns of planned rehabilitation at discharge from stroke units in Sweden in 2011 and 2017 and identify explanatory variables for planned rehabilitation. Multivariable binary logistic regression was used to identify variables that could explain planned rehabilitation. There were 19,158 patients in 2011 and 16,508 patients in 2017 with stroke, included in the study. In 2011, 57% of patients were planned for some form of rehabilitation at discharge from stroke unit, which increased to 72% in 2017 (p < 0.001). Patients with impaired consciousness at admission had increased odds for planned rehabilitation (hemorrhage 2011 OR 1.43, 95% CI 1.13–1.81, 2017 OR 1.66, 95% CI 1.20–2.32), (IS 2011 OR 1.21, 95% CI 1.08–1.34, 2017 OR 1.49, 95% CI 1.28–1.75). Admission to a community hospital (hemorrhage 2011 OR 0.56, 95% CI 0.43–0.74, 2017 OR 0.39, 95% CI 0.27–0.56) (IS 2011 OR 0.63, 95% CI 0.58–0.69, 2017 OR 0.54, 95% CI 0.49–0.61) or to a specialized non-university hospital (hemorrhage 2017 OR 0.66, 95% CI 0.46–0.94), (IS 2011 OR 0.90, 95% CI 0.82–0.98, 2017 OR 0.76, 95% CI 0.68–0.84) was associated with decreased odds of receiving planned rehabilitation compared to admission to a university hospital. As a conclusion severe stroke was associated with increased odds for planned rehabilitation and patients discharged from non-university hospitals had consistently decreased odds for planned rehabilitation.

scholarly journals The Stroke Unit Story: Where Have We Been and Where Are We Going?

2021 ◽  
pp. 1-8
Author(s):  
Peter Langhorne
Keyword(s):  
Collaborative Research ◽  
Stroke Unit ◽  
Final Section ◽  
Evidence Base ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Stroke Units ◽  
History Of ◽  
Stroke Unit Care ◽  
Stroke Type

<b><i>Background:</i></b> The concept of stroke unit care has been discussed for over 50 years, but it is only in the last 25 years that clear evidence of its effectiveness has emerged to inform these discussions. <b><i>Summary:</i></b> This review outlines the history of the concept of stroke units to improve recovery after stroke and their evaluation in clinical trials. It describes the first systematic review of stroke unit trials published in 1993, the establishment of a collaborative research group (the Stroke Unit Trialists’ Collaboration), the subsequent analyses and updates of the evidence base, and the efforts to implement stroke unit care in routine settings. The final section considers some of the remaining challenges in this area of research and clinical practice. <b><i>Key Messages:</i></b> Good quality evidence confirms that stroke patients who are looked after in a stroke unit are more likely to survive and be independent and living at home 1 year after their stroke. The apparent benefits are independent of patient age, sex, stroke type, or initial stroke severity. The benefits are most obvious in units based in a discrete ward (stroke ward). The current challenges include integrating effective stroke units with more recent systems to deliver hyper-acute stroke interventions and implementing stroke units in lower resource regions.

Organisierte Behandlung in einer Stroke Unit -Voraussetzung zur optimierten Behandlungdes akuten Hirnschlages

2012 ◽  
Vol 69 (9) ◽  
pp. 549-553
Author(s):  
A. Lyrer ◽  
Bonati ◽  
Michel
Keyword(s):  
Stroke Unit ◽  
Stroke Units

Eine Stroke Unit (SU) ist eine Behandlungseinheit eines Spitals, die für Hirnschlagpatienten konzipiert ist. Die Behandlung in einer SU ist für alle Schweregrade und alle Altersgruppen von Patienten mit Hirnschlag wirksam. Sie verfügt über monitorisierte und nicht-monitorisierte Behandlungsplätze. Patienten, die in Stroke Units behandelt werden, haben - im Vergleich zur herkömmlichen, weniger strukturierten Behandlung - eine signifikant höhere Wahrscheinlichkeit zu überleben, ihre Selbständigkeit wieder zu erlangen und nach Hause zurückzukehren. Eine Behandlung in einer organisierten Einheit gewährleistet aber auch die die Applikation von Einzelmaßnahmen, wie z. B. die Thrombolyse, die nachweislich eine Wirksamkeit mit günstigem Einfluss auf den Verlauf haben.

Die intrazerebrale Hirnblutung: Akutes Ereignis und chronische Erkrankung

2021 ◽  
Vol 78 (6) ◽  
pp. 320-327
Author(s):  
Martina Göldlin ◽  
Piotr Radojewski ◽  
Bernhard Siepen ◽  
Madlaine Müller ◽  
Roland Wiest ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Chronische Erkrankung ◽  
Care Bundle ◽  
Antithrombotische Therapie ◽  
Interdisziplinäre Behandlung ◽  
Stroke Center

Zusammenfassung. Die intrazerebrale Hirnblutung ist für ca. 10–15% aller Hirnschläge verantwortlich und betrifft in der Schweiz ca. 1’500–2’000 Patienten pro Jahr. Bei der Akutbehandlung ist eine interdisziplinäre Behandlung durch spezialisierte Experten in einer zertifizierten Stroke Unit oder einem Stroke Center von entscheidender Bedeutung. Ein simples ABC-care bundle (Antikoagulation revertieren, Blutdruck kontrollieren, Neurochirurgen informieren) kann das Outcome signifikant verbessern. Trotz einer hohen Mortalität sind ca. ein Drittel aller Patienten nach einer Hirnblutung funktionell unabhängig und der weitverbreitete Pessimismus ist unangebracht. Über 80% aller Hirnblutungen werden durch verschiedene Formen cerebraler Mikroangiopathien verursacht und die Risiken für eine erneute Hirnblutung oder einen ischämischen Hirnschlag unterscheiden sich deutlich. Hirnblutungspatienten sind vaskuläre Hochrisikopatienten mit einer chronischen, cerebrovaskulären Erkrankung. Sie sollten langfristig und regelmässig von neurovaskulären Spezialisten behandelt werden, um wichtige Fragen (Blutdruckmanagement, antithrombotische Therapie/Antikoagulation, spezialisierte Neurorehabilitation zur Verbesserung insbesondere neurokognitiver Defizite, Therapie zusätzlicher Komplikationen, z. B. Epilepsie) individuell zu klären und die optimale Behandlung für die Patienten zu gewährleisten. Viele aktuelle Studien werden in den nächsten Jahren wichtige Ergebnisse liefern, um die Behandlung der Hirnblutung weiter zu verbessern.

Abstract TP365: Think Big: Weekly Stroke Education for Registered Nurses on the Stroke Unit

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Betty Robertson
Keyword(s):  
Systems Of Care ◽  
Stroke Care ◽  
Interesting Case ◽  
Stroke Patients ◽  
Stroke Units ◽  
Optimal Outcomes ◽  
Information Research ◽  
Stroke Education ◽  
Stroke Systems Of Care ◽  
Stroke Center

Background: Nurses play a pivotal role in all phases of care of the stroke patient. Stroke Nurses have responded to the challenge of making stroke systems of care a reality in recent years. We wanted our stroke nurses to use evidence-based practice to organize and deliver stroke services and facilitate optimal outcomes for stroke patients. One of the most important components of a Stroke Program is having a designated unit where patients receive specialized stroke care. Nurses who are a part of a stroke center should be trained to recognize medical complications that can arise in someone who has suffered a stroke. One of the most important reasons why primary stroke centers are the premier places for the treatment of strokes is that, by having specialized stroke units, patients have better outcomes. Is weekly stroke education for RNs on the stroke floor helpful to the nurses?<br Does it influence or impact the way they care for their patients? Methods: Since information,research and even nursing staff is always changing, education needs to be provided to nurses taking care of stroke patients so they have the latest and greatest knowledge to share with their patients and loved ones. We asked the staff what topic they wanted to cover and posted a suggestion box on the unit entitled “Ask a Stroke Nurse,” analyzed the attendance and did a survey to get the nurses’ feedback. Collectively we decided the best way to capture all staff on all shifts was to do weekly in-services and education sessions covering everything from Journal articles, updates about the program, interesting case studies, breaking science and even guest speakers from other departments. Conclusion: The survey showed that 96% of RNs on the stroke floor found the weekly education very valuable. 96% found that it positively impacted their practice,additionally, 91% said it greatly increased their knowledge about stroke & TIA. We will continue weekly education and continue to get feedback from the nurses. This endeavor has proven to be a very successful. We were pleased to see the positive comments from the staff about how much they enjoy and look forward to the classes each week.

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