Centralized stroke care reduces mortality, hospital stays

British stroke patients are seeing improvements in areas where full centralization of stroke care has occurred, according to an article published online Aug. 5 in BMJ.

Comparing London with Greater Manchester, two cities where centralization has been implemented to different degrees, against the rest of England, London saw the greatest overall reduction in mortality. Stephen Morris, PhD, of the University College of London’s Department of Applied Health Research, and colleagues proposed that this is due to how London implemented centralization.

In London, the system was designed to ensure that all Londoners would have access to hyperacute stroke units no more than 30 minutes away by ambulance. While a similar model was intended in Greater Manchester, primary, comprehensive stroke centers are purely for thrombolysis and only patients within four hours of developing stroke symptoms are taken. All other patients in Greater Manchester are taken to less specialized stroke centers or hospitals for care.

Morris et al noted that this has made a significant impact on mortality. While no difference was seen between Greater Manchester and the rest of England, London saw reductions in mortality at three days (17 percent), 30 days (7 percent) and 90 days (5 percent) post-stroke.

Both Manchester and London saw reductions in hospital stays compared with the rest of England. Manchester saw an average reduction of two days per patient while London had a reduction of 1.4 days per patient, representing a 9 percent and 7 percent reduction in length of stay, respectively.

They found that the reductions in both length of stay and mortality were largely achieved in ischemic stroke patients, representing 68 percent of the patient cases reviewed.

Morris et al noted that the London findings were consistent with both other research done on London stroke units and other areas where centralization is being implemented. “This suggests that the centralized model of care in London more closely adhered to and achieved greater compliance with care processes,” they wrote. The results from Greater Manchester, they determined, correlated with how centralized specialist care throughout hyperacute stroke units affect individual patient outcomes.

“The upshot is that differences in mortality can be explained by the lower level of adherence in Greater Manchester or by differences between the two systems in terms of access to hyperacute care for patients presenting after four hours of developing symptoms of stroke,” Morris et al wrote. They suggested utilizing this data to redesign services for improved outcomes in the future.