Stroke unit care
The organisation of hospital services to provide stroke unit care is the single most
important recommendation for improving stroke management12. Stroke unit care
significantly reduces death and disability after stroke compared with conventional care in
general wards for all people with stroke16. It has been estimated that stroke unit care
reduces death and disability by 20%26. While numbers of stroke units and stroke unit beds
in WA have increased to 73 since 2007, only 50% of stroke patients receive stroke unit
care26.
In some areas of WA, the number of people with stroke requiring care is not high enough
to support the need for a dedicated stroke unit and maintain staff expertise. Rural
residents, and particularly Aboriginal populations do not have universally adequate access
to a stroke unit, which can result in suboptimal outcomes67. To ensure equitable and timely
service for all stroke survivors, support for non specialist sites in both metropolitan and
regional areas may be facilitated via formal or informal networks and appropriate
resourcing needs to be provided based on patient demand. Access to more specialised
medical or allied health services may also be facilitated through the use of telemedicine12.
Standard resources and care pathways across stroke units and ESD programs can be
developed and used, including common assessment tools and outcome measures.
Additionally acute care facility medical diagnostic investigations should be readily
accessible for patients/medical staff at this point of assessment. This can be enhanced by
anticipating demand and pre-booking services.
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The Acute Stroke Services Framework 201118 provides a comprehensive outline to assist
health services to structure acute stroke services by outlining recommended structures,
networks, settings and criteria for monitoring. See Table 8 below for more details.
Predicting future requirements for bed numbers is complex and was previously modelled in
the MSC 2006 based on stroke episodes in WA public hospitals and average length of
stay. The WA Health Clinical Services Framework 2010-20207
provides some guidance for
future service planning and bed number modelling. Implementation of the MSC 2012 will
require more detailed analysis of demands for acute and rehabilitative beds across WA to
provide recommendations for stroke specific service planning.