European Stroke Organisation certification of stroke units and stroke centres

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.

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Stroke units: research in practice

10.1093/med/9780199689644.003.0013 ◽

2015 ◽

Author(s):

Lalit Kalra

Keyword(s):

Stroke Unit ◽

Stroke Care ◽

Evidence Base ◽

Multidisciplinary Teams ◽

Stroke Patients ◽

Stroke Units ◽

Key Points ◽

Stroke Unit Care ◽

Rehabilitation Needs ◽

Therapy Sessions

Key points• Stroke units are the cornerstone of quality stroke care.• The benefits of stroke unit care are supported by a very strong evidence base• In 2007 the National Stroke Strategy mandated that all stroke patients should have prompt access to stroke unit care.• Despite policy and guidelines, only 62% stroke patients were treated on specialist stroke units in 2010.• Patients spend long periods of inactivity on stroke units; multidisciplinary teams need to encourage rehabilitation activities outside therapy sessions.• Rehabilitation needs to be family- and carer-oriented to prepare patients for life after discharge.

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Organizational issues in stroke treatment: The Swiss paradigm - Stroke units

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.116450 ◽

2013 ◽

Vol 04 (S 01) ◽

pp. S131-S133 ◽

Cited By ~ 2

Author(s):

Georgios K Matis ◽

Olga I Chrysou ◽

Theodossios A Birbilis

Keyword(s):

Multidisciplinary Care ◽

Stroke Care ◽

Stroke Units ◽

Stroke Treatment ◽

Organizational Issues ◽

Standardized Treatment ◽

Socioeconomic Burden ◽

New Guidelines ◽

Acute Rehabilitation ◽

Prompt Diagnosis

ABSTRACTStroke represents the leading cause of acquired disability in adults and poses a tremendous socioeconomic burden both on patients and the society. In this sense, prompt diagnosis and urgent treatment are needed in order to radically reduce the devastating consequences of this disease. Herein the authors present the new guidelines recently adopted by the Swiss Stroke Society concerning the establishment of stroke units. Standardized treatment and allocation protocols along with an acute rehabilitation concept seem to be the core of the Swiss stroke management system. Coordinated multidisciplinary care provided by specialized medical, nursing and therapy staff is of utmost importance for achieving a significant dependency and death reduction. It is believed that the implementation of these guidelines in the stroke care system would be beneficial not only for the stroke patients, but also for the health system.

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Ten Years of Improving Acute Stroke Management in a Metropolitan Area: A Population-Based Quantification of Quality Indicators

European Neurology ◽

10.1159/000518428 ◽

2021 ◽

pp. 1-11

Author(s):

Anna Alegiani ◽

Michael Rosenkranz ◽

Leonie Schmitz ◽

Susanne Lezius ◽

Günter Seidel ◽

...

Keyword(s):

Acute Stroke ◽

Quality Indicators ◽

Metropolitan Area ◽

Stroke Care ◽

Care Quality ◽

Acute Stroke Care ◽

Stroke Units ◽

Stroke Treatment ◽

Acute Stroke Treatment ◽

Over Time

Background and Purpose: Rapid access to acute stroke treatment improves clinical outcomes in patients with ischemic stroke. We aimed to shorten the time to admission and to acute stroke treatment for patients with acute stroke in the Hamburg metropolitan area by collaborative multilevel measures involving all hospitals with stroke units, the Emergency Medical Services (EMS), and health-care authorities. Methods: In 2007, an area-wide stroke care quality project was initiated. The project included mandatory admission of all stroke patients in Hamburg exclusively to hospitals with stroke units, harmonized acute treatment algorithms among all hospitals, repeated training of the EMS staff, a multimedia educational campaign, and a mandatory stroke care quality monitoring system based on structured data assessment and quality indicators for procedural measures. We analyzed data of all patients with acute stroke who received inhospital treatment in the city of Hamburg during the evaluation period from the quality assurance database data and evaluated trends of key quality indicators over time. Results: From 2007 to 2016, a total of 83,395 patients with acute stroke were registered. During this period, the proportion of patients admitted within ≤3 h from symptom onset increased over time from 27.8% in 2007 to 35.2% in 2016 (p < 0.001). The proportion of patients who received rapid thrombolysis (within ≤30 min after admission) increased from 7.7 to 54.1% (p < 0.001). Conclusions: Collaborative stroke care quality projects are suitable and effective to improve acute stroke care.

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Stroke Rehabilitation 2007: What Should it Be?

International Journal of Stroke ◽

10.1111/j.1747-4949.2007.00146.x ◽

2007 ◽

Vol 2 (3) ◽

pp. 191-200 ◽

Cited By ~ 24

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.

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

Cerebrovascular Diseases ◽

10.1159/000518934 ◽

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

Background: 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. Summary: 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. Key Messages: 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.

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Economic evaluation of the Melbourne Mobile Stroke Unit

International Journal of Stroke ◽

10.1177/1747493020929944 ◽

2020 ◽

pp. 174749302092994 ◽

Cited By ~ 1

Author(s):

Joosup Kim ◽

Damien Easton ◽

Henry Zhao ◽

Skye Coote ◽

Garveeta Sookram ◽

...

Keyword(s):

Stroke Unit ◽

Standard Care ◽

Stroke Care ◽

Reperfusion Therapy ◽

Sensitivity Analyses ◽

Local Data ◽

Endovascular Thrombectomy ◽

Stroke Treatment ◽

Mobile Stroke Unit ◽

Life Years

Background The Melbourne Mobile Stroke Unit (MSU) is the first Australian service to provide prehospital acute stroke treatment, including thrombolysis and facilitated triage for endovascular thrombectomy. Aims To estimate the cost-effectiveness of the MSU during the first full year of operation compared with standard ambulance and hospital stroke care pathways (standard care). Methods The costs and benefits of the Melbourne MSU were estimated using an economic simulation model. Operational costs and service utilization data were obtained from the MSU financial and patient tracking reports. The health benefits were estimated as disability-adjusted life years (DALYs) avoided using local data on reperfusion therapy and estimates from the published literature on their effectiveness. Costs were presented in Australian dollars. The robustness of results was assessed using multivariable (model inputs varied simultaneously: 10,000 Monte Carlo iterations) and various one-way sensitivity analyses. Results In 2018, the MSU was dispatched to 1244 patients during 200 days of operation. Overall, 167 patients were diagnosed with acute ischemic stroke, and 58 received thrombolysis, endovascular thrombectomy, or both. We estimated 27.94 DALYs avoided with earlier access to endovascular thrombectomy (95% confidence interval (CI) 15.30 to 35.93) and 16.90 DALYs avoided with improvements in access to thrombolysis (95% CI 9.05 to 24.68). The MSU was estimated to cost an additional $30,982 per DALY avoided (95% CI $21,142 to $47,517) compared to standard care. Conclusions There is evidence that the introduction of MSU is cost-effective when compared with standard care due to earlier provision of reperfusion therapies.

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“It’s Lonely”: Patients’ Experiences of the Physical Environment at a Newly Built Stroke Unit

HERD Health Environments Research & Design Journal ◽

10.1177/1937586718806696 ◽

2018 ◽

Vol 12 (3) ◽

pp. 141-152 ◽

Cited By ~ 3

Author(s):

Anna Anåker ◽

Lena von Koch ◽

Ann Heylighen ◽

Marie Elf

Keyword(s):

Physical Environment ◽

Stroke Unit ◽

Well Being ◽

Stroke Care ◽

Stroke Units ◽

Healthcare Facilities ◽

Room Design ◽

Single Room ◽

Starting Point ◽

Communal Areas

Objective: The aim of this study was to explore patients’ experiences of the physical environment at a newly built stroke unit. Background: For a person who survives a stroke, life can change dramatically. The physical environment is essential for patients’ health and well-being. To reduce infections, a majority of new healthcare facilities mainly have a single-room design. However, in the context of stroke care, knowledge of how patients experience the physical environment, particularly their experience of a single-room design, is scarce. Method: This study used a qualitative design. Patients ( n = 16) participated in semistructured individual interviews. Data were collected in December 2015 and February 2017 in Sweden; interviews were transcribed verbatim and analyzed using content analysis. Results: Two main themes were identified: (i) incongruence exists between community and privacy and (ii) connectedness with the outside world provides distraction and a sense of normality. In single rooms, social support was absent and a sense of loneliness was expressed. Patients were positively distracted when they looked at nature or activities that went on outside their windows. Conclusions: The physical environment is significant for patients with stroke. This study highlights potential areas for architectural improvements in stroke units, primarily around designing communal areas with meeting places and providing opportunities to participate in the world outside the unit. A future challenge is to design stroke units that support both community and privacy. Exploring patients’ experiences could be a starting point when designing new healthcare environments and inform evidence-based design.

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Improving Outcomes After Stroke: From Stroke Units to Mobile Stroke Units

Stroke ◽

10.1161/strokeaha.121.034616 ◽

2021 ◽

Author(s):

Andrei V. Alexandrov ◽

Yongchai Nilanont

Keyword(s):

Stroke Care ◽

Absolute Difference ◽

Clinical Approach ◽

Stroke Units ◽

Stroke Treatment ◽

Golden Hour ◽

Systemic Thrombolysis ◽

Improved Outcomes ◽

Mobile Stroke Unit ◽

The Impact

A proactive clinical approach to stroke care improved functional outcomes with implementation of specialized in-hospital stroke units, urgently delivered systemic thrombolysis, mechanical thrombectomy and most recently with mobile stroke units deployed in the field. An 18% absolute difference in outcomes as a shift across all modified Rankin Scale strata at 3 months in the recent Berlin study may not be explained by just 8.8% more patients treated within the golden hour for thrombolytic treatment from symptom onset. These findings parallel the findings in the largest controlled multi-center BEST-MSU trial (Benefits of Stroke Treatment Delivered Using a Mobile Stroke Unit) to date. A shortcoming in blinding of the investigators to the mode of transportation is similar to blinding to the endovascular treatment in PROBE (Prospective Randomized Open, Blinded End-Point) design used in thrombectomy trials. A faster access to stroke experts and brain imaging in the field for all patients suspect of stroke regardless symptom nature, severity, duration or resolution delivered by mobile stroke units is likely the reason for improved outcomes akin the impact observed in the initial multidisciplinary approach to in-hospital stroke units and reperfusion therapies delivery.

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Abstract 115: Current Status of Acute Stroke Management in Korea: A Nationwide Report Based on 19,608 Patients Treated in 216 Hospitals

Stroke ◽

10.1161/str.51.suppl_1.115 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Jun Yup Kim ◽

Keon-Joo Lee ◽

Jihoon Kang ◽

Beom Joon Kim ◽

Seong-Eun Kim ◽

...

Keyword(s):

Acute Stroke ◽

Stroke Unit ◽

National Level ◽

Stroke Care ◽

Current Status ◽

Endovascular Coiling ◽

Stroke Management ◽

Acute Stroke Care ◽

Survey Period ◽

Stroke Units

Introduction: There have been few reports on status of acute stroke management at a national level worldwide, and none in Korea. This study is aimed to describe the current status and disparities of acute stroke management in Korea. Methods: Data from 5th (2013) and 6th (2014) national surveys for assessing quality of acute stroke care were used. Patients with principal diagnosis codes indicating subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), ischemic stroke (IS), who were admitted via emergency rooms within 7 days of onset at hospitals treating 10 or more stroke cases during the each 3-month survey period were selected. Results: A total of 19,608 stroke cases (age, 67.7±13.5years; female, 45%; IS, 76%; ICH, 15%; SAH, 9%) treated in 216 hospitals were analyzed. Thirty-one percent of hospitals had stroke units and 41% of stroke cases were treated at hospitals without stroke units. In IS, IV thrombolysis (IVT) and endovascular treatment (EVT) rates were 10.7% and 3.6%, respectively. Thirty-nine percent of IVT and fifty-two percent of EVT cases were performed in hospitals with annual volume of <25 IVT and <15 EVT. Centralization of EVT showed disparities by region (Figure). Carotid endarterectomy, carotid artery stenting, decompressive, bypass surgery was conducted in 0.2%, 1.4%, 1.0%, 0.2% of IS cases; decompressive surgery was done in 28.1% of ICH cases; surgical clipping, endovascular coiling was done in 17.2%, 14.3% of SAH cases, respectively. There were noticeable regional disparities in various interventions, use of ambulance, arrival time and provision of stroke unit service. Conclusions: This study is the first report on the status of acute stroke care in Korea on a national level. Large number of recanalization therapies were performed in low-volume-hospitals. Expansion of stroke unit service, stroke center certification or accreditation, and connections between stroke centers and EMS are highly recommended.

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Preferences, barriers and facilitators for establishing comprehensive stroke units: a multidisciplinary survey

Australian Health Review ◽

10.1071/ah12026 ◽

2013 ◽

Vol 37 (3) ◽

pp. 318 ◽

Cited By ~ 3

Author(s):

Fintan O'Rourke ◽

Daniel K.Y. Chan ◽

Daniel L. Chan ◽

Xiao Man Ding

Keyword(s):

Stroke Unit ◽

Allied Health ◽

Stroke Care ◽

Perceived Barriers ◽

Stroke Units ◽

Rehabilitation Care ◽

Unit Model ◽

Stroke Team ◽

Stroke Unit Care ◽

Optimum Model

Objectives. To determine the preferences of multidisciplinary stroke clinicians for models of inpatient stroke unit care and perceived barriers to establishing a comprehensive stroke unit (CSU) model (acute and rehabilitation care in the same ward). Methods. Written questionnaires distributed and completed at multidisciplinary stroke unit case conferences in NSW, Australia. Results. Twenty hospitals with 22 stroke units were surveyed, 13 acute stroke units, 7 rehabilitation stroke units, 2 CSUs. Two hundred and twenty-eight respondents: 99 (43.4%) allied health, 72 (31.6%) nurses and 57 (25.0%) doctors. One hundred and fifty-one respondents (67.0%) thought CSU to be the best model. Seventy-three % of doctors and 79% of allied health preferred CSU v. 57% of nurses (P = 0.041). Of doctors, rehabilitation specialists were most likely to favour comprehensive model (84.2%) and neurologists least (57.0%). The main perceived advantages of CSU were reduced cost and improved functional outcomes; perceived disadvantages were increased workload and unwell patients unable to participate in rehabilitation. Main perceived barriers to establishing CSU were lack of space, money, staffing and time. Conclusion. Although most current stroke unit care in NSW is based on the traditional model of acute and rehabilitation components in separate wards or hospitals, the majority of multidisciplinary stroke team clinicians believe CSU is the optimum model. What is known about the topic? Stroke unit care is known to improve survival and dependency but the optimum model of care is unproven, despite some small studies suggesting that the CSU model may result in better outcomes. What does this paper add? This paper is the first to survey stroke clinicians from various disciplines and types of unit, to determine their preferences for stroke unit model. What are the implications for practitioners? A majority of clinicians expressed a preference for the CSU model, suggesting that most would be comfortable caring for patients in both acute and rehabilitation phases of stroke care if further such units are established.

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