stroke units

13
May 2013 Inservice

Upload: herman

Post on 10-Jan-2016

43 views

Category:

Documents


0 download

DESCRIPTION

Stroke Units. May 2013 Inservice. This inservice is an opinion piece authored by Isobel, and based on her “read” of the evidence. Please note: all health professionals should refer to, and critically appraise the relevant, available evidence for themselves. Objectives. This inservice will: - PowerPoint PPT Presentation

TRANSCRIPT

Page 1: Stroke Units

May 2013 Inservice

Page 2: Stroke Units

• This inservice will:• Explore the history of Stroke Units• Define five different Stroke Unit models• Investigate the impact of Stroke Unit care in today’s

health service• Raise one issue of concern

• This inservice will:• Explore the history of Stroke Units• Define five different Stroke Unit models• Investigate the impact of Stroke Unit care in today’s

health service• Raise one issue of concern

Stroke Unit care is the single, most effective intervention that is

currently available to most people diagnosed with a stroke that’s less

than 4 weeks post-event.

This inservice is an opinion piece authored by Isobel, and based on her “read” of the evidence. Please

note: all health professionals should refer to, and critically appraise

the relevant, available evidence for themselves

Page 3: Stroke Units

When were Stroke Units first introduced and why?

Page 4: Stroke Units

• Back in 1998, Langhorne and Dennis reported their original findings as a British Medical Journal booklet titled: "Stroke Units: An evidence based approach".

• These authors coined the phrase "Stroke Units". • Since then, the group of authors publishing ongoing

results refer to themselves as the Stroke Unit Trialists Collaboration (SUTC)

• Their evidence has demonstrated that people cared for in Stroke Units are 20% more likely to survive, go home and be independent!!

• Therefore, Stroke Units are the single, most effective intervention currently available to most people diagnosed with recent stroke

A truly amazing intervention! But, as most of you will realise, Stroke Units were introduced prior to the advent of post-stroke thrombolysis, and in

turn, the introduction of Acute Stroke Units.

Page 5: Stroke Units

Good question! •What did Langhorne & Dennis (1998) define as a Stroke Unit?•What they found was that “organised” care post-stroke was responsible for the 20% -better benefit. •They found “organised care” (Stroke Unit care) had 5 significant components:

1. Geographically-designated stroke beds2. A multi-professional (MP) team approach3. An MP team that was enthused and educated in stroke4. An MP that met formally at least once a week5. Early involvement of the family

Page 6: Stroke Units

Different hospitals have different Stroke Units. What are they and how do they differ?

Page 7: Stroke Units

• From my experience and my ‘read’ of the evidence, there are currently 5 different stroke models of care. All of these models have a multi-professional team and geographically-designated beds.

• In no particular order, they are:

Stroke Unit (SU) Model

Acronym Thrombolysis plus intensive monitoring

Approximate length of stay

Rehabilitation

Hyper-acute SU HASU √ 12 -24 hours No

Acute SU ASU √ 2-3 days Limited

Comprehensive SU

CSU √ 0-21 days √

Stroke Unit SU No 0-21 days √

Rehabilitation SU

RSU No 5-28 days √

As you’ll see, it’s only the

Comprehensive Stroke Unit that offers “all of the

above”

Page 8: Stroke Units

• The Hyper-acute Stroke Unit (HASU). This is the most recently introduced model. It provides 24 hour, intensive care, to people who are only a few hours post-stroke.

• The Acute Stroke Unit (ASU), provides 24 hour monitoring in the first few hours, and semi-intensive monitoring in the first few days. After that, patients must be transferred to…??..hmm..

• A Comprehensive Stroke Unit (CSU) is what I’d want to be admitted to if I’d been diagnosed with stroke. It’s a one-stop shop where patients can stay for their entire admission.

• A Stroke Rehabilitation Unit is usually a set of stroke-designated beds that are part of a larger Rehabilitation Unit.

The Stroke Unit, which was the original model of care, obviously, was

demonstrated to be sooooo…. effective that they were introduced in as many

hospitals as possible. The evidence was simply too difficult to ignore! This is one of the great success stories of applying

an evidence-based approach.

But, evidence is a shifting landscape as this unfolding story demonstrates.

Evidence demonstrating the efficacy of post-stroke thrombolysis meant that the SU model was not sufficient. Hence the multiplicity of models as Stroke teams responded to the emerging evidence.

Page 9: Stroke Units

Does it matter which Stroke Unit model is being used?

Page 10: Stroke Units

• Despite the unfolding Stroke Unit story, the Stroke Unit Trialists’ Collaboration (SUTC) evidence still stands. To date, no other intervention has been shown to have a 20%-better benefit.

• As opposed to post-stroke thrombolysis, Stroke Unit care is simply a reorganisation of what is usually already there! Nurses, doctors, therapists and some neuro beds.

• Designate some beds, introduce stroke education, employ the enthused, formalise the team meetings and involve the carers and hey presto - you have a Stroke Unit!

• Thousands of Stroke Units have been established across the world in response to this watershed evidence. It has quite literally, revolutionised how we ‘do’ stroke

Page 11: Stroke Units

Go to…… •The Cochrane Library: http://summaries.cochrane.org/CD000197/organised-inpatient-stroke-unit-care-for-stroke•Google and search for Stroke Units and Langhorne and you’ll find articles like these two: • Stroke Unit Trialists’ Collaboration (1997) How do Stroke

Units improve patient outcomes? Stroke, 28, 2139-2144• Langhorne, Pollack et al (2002) What are the components of

effective Stroke Unit care? Age and Aging, 31(5), 365-371

•YouTube and search for Langhorne and Stroke Units and you’ll find a series of interesting presentations

Page 12: Stroke Units

Something to think about!

Page 13: Stroke Units

• Because the Stroke Unit evidence is so compelling, I have one major concern.

• As I alluded to before, are some patients being classified as receiving “Stroke Unit” care, when that care may have only been provided to them for a couple of days?

Let me explain……….• More hospitals have an Acute Stroke Unit (ASU), but,

if a patient receives 2 days of ASU care and is then transferred onto the neurology ward, and, in a few days time, transferred on to a rehabilitation facility, can we claim they have received Stroke Unit care?

• I’m not sure and this is my concern………..

But, as I said right at the start, this is just my humble opinion. Please don’t get me wrong, I’m certainly not against Acute Stroke Units; just

concerned that they may be denying some patients the additional benefits of Stroke Unit Care….hmmm….time

will tell…