Improvement in stroke care after establishment of the Stroke Unit

Objective: To determine whether there was an improvement in stroke care after the establishment of the Stroke Unit at the Institute of Neurology, National Hospital of Sri Lanka.

Design: The process of acute stroke care was evaluated by retrospective case record analysis of 192 patients with stroke admitted to the Stroke Unit. These results were compared with a previous audit of 263 patients treated in the neurology wards. The two audits used identical methodology, and were conducted using an audit package developed by the Royal College of Physicians of London.

Methods: Sixty audit items related to stroke care were assessed, and compared between the two audits. Performance for each item was recorded as a percentage, and was graded from ‘very poor’ to ‘very good’. The difference between the two audits for each item was expressed as an odds ratio (OR).

Results: Care was graded as ‘very good’ or ‘good’ for 56.7% of audit items, compared to 20% in the first audit. Significant improvements in care (OR>1.0, p<0.05) were noted in 50 out of the 60 audit items. Large improvements were seen in assessment of risk factors, CT scanning, rehabilitation oriented clinical assessments and initiation of secondary preventive measures.

Conclusion: Establishment of the Stroke Unit has led to significant improvements in the process of stroke care.