Study shows new stroke units save lives 

02/08/2013 00:00 

New research from UCLPartners has shown that specialist hyper acute stroke units like the one at UCLH have led to significant reductions in both mortality and costs.

Charlie Davie

UCLH consultant neurologist Dr Charlie Davie


Before 2010, stroke services in London were provided in 30 acute hospitals across the region. After July 2010, a new multiple hub-and-spoke model for acute stroke care was implemented across the whole of London, with continuous specialist care for patients during the first 72 hours following a stroke provided at eight hyper-acute stroke units (HASUs).

Each HASU was to provide hyper-acute stroke care in the first 72 hours for all suspected stroke patients and, in addition, a larger number of acute stroke units with enhanced specialist care and multi-therapy rehabilitation for those patients requiring ongoing in-patient care beyond 72 hours. 

John Parker, 67, of Tufnell Park north London was treated for a mini stroke some years ago at his local hospital, and has since benefited from the specialist services of UCLH’s hyper acute stroke unit following a stroke in July.

He said: “I feel very lucky to live in London and I really saw the benefits of going to a specialist centre this time. When I arrived at UCLH, I was seen straight away and they were really geared up for treating me.” Following discharge to his local stroke unit at the Royal Free London, John was able to go home a few days later with a clear plan for his on-going care, including physiotherapy and occupational therapy.

For the first time, this study reveals differences in clinical outcomes and costs between the new and old models. The researchers found that the predicted survival rates at 90 days were 81.5% before the new model was implemented, and 88.7% after. After adjusting for the reduction in stroke mortality that had occurred elsewhere in the UK, it was calculated that there was a relative reduction in deaths of 12% after the new system was implemented.  This means that over 400 lives in London were saved since 2010.  If this were mapped across the country, potentially over 2,100 lives could be saved each year.

The new model required some upfront financial investments and increased costs per patient in the first 72 hours due to the more intensive, specialist care provided to patients, but the total average 90 day cost per patient was £811 lower in the new system. This was mostly due to a reduction in the average length of hospital stay.

The study also demonstrated a marked increase in thrombolysis rates (administration of vital clot-busting drugs) from 5% to 12% following the reconfiguration.

The study, which is published in the journal PLOS ONE, was undertaken by health economists from across the NHS in London and Massachusetts General Hospital, including UCLH consultant neurologist Dr Charlie Davie.

“Our study shows that a system directing patients to high quality stroke units in the first 72 hours following stroke saves lives and money. The centralised model worked well in London because of the high density population and the hospital distribution that permitted ambulance travel times to remain within viable limits,” says Dr Davie, UCLPartners Director of Neuroscience and Consultant Neurologist at The Royal Free London NHS Foundation Trust. “Our study could be used to support the implementation of similar models in other large populations, and further research is ongoing to examine whether the London model is viable in other geographical and clinical settings.”

UCLPartners

UCLPartners is an academic health science partnership that supports the healthcare system serving over six million people. It is one of the world’s leading centres of medical discovery and healthcare innovation.  Its mission is to deliver health improvement and create wealth for the UK through excellence in innovation, education and discovery.

www.uclpartners.com

 

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