Establishment of stroke ward results in immediate reduction of major complications

OBJECTIVE: Randomized controlled trials have consistently shown that stroke units decrease both mortality & morbidity compared with conventional care in general medical wards. There is limited data on specific types of in-hospital medical complications & their effect on outcome. The objective of this study was to determine whether establishing a specialized geographically defined Stroke Ward results in reduced complications in patients suffering from acute stroke within the same hospital system. Methods: This is a prospective study from January 2014-October 2014. Data was collected from a web-based stroke registry in two phases. In Phase 1 (from January 1, 2014 till March 08, 2014) data was collected on stroke patients admitted in medical wards. In phase 2, a protocol-based multidisciplinary care Stroke Ward became operational, admitting most of the patients. Outcomes measures were number & type of complications, mortality, discharge disposition, & length of stay, & were adjusted for age, sex, & medical comorbidities. Results: There were 130 admissions in phase-1 & 577 in phase-2. Common complications include aspiration pneumonia 29[percnt] vs 15[percnt] (p<0.001) & pressure ulcers in 35[percnt] vs 12[percnt] (p<0.001). Average length of stay decreased from 12 to 4.7 days (p<0.001). In phase-1, 70 [percnt] patients were discharged home, while 23[percnt] were transferred to rehabilitation, while in phase-2, 73[percnt] patients were discharged home, while 20[percnt] patients were sent to rehabilitation. Most (82[percnt]) complications happened in medical wards, mainly in patients who over stayed in emergency department (more than 8 hours) waiting for bed in Stroke Ward or medical floor. Conclusion: A protocol based multidisciplinary care Stroke Ward care significantly reduces common early complications of acute stroke. It also helps in significantly reducing the length of stay, saving total bed days at a tertiary care hospital, hence improving the overall care of these patients.