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Centralising stroke care in specialist units has saved lives

Centralising stroke services can save the lives of patients and reduce the number of days people spend in hospital, a new study suggests.

Having specialist centres in fewer hospitals means patients have access to stroke experts 24 hours a day, seven days a week.

New research examining the centralisation of services in London and the partial-concentration of services in Manchester found that in the capital almost 100 fewer patients die every year thanks to the remodelling of services.

“The changes in London save around 96 stroke patients every year”

Stephen Morris

The authors said that other urban areas should “seriously consider” adopting a similar model as the one in London.

In 2010, stroke services were remodelled across the two cities. In London 30 hospitals providing stroke care were concentrated to eight “hyperacute units” where patients are taken to one of the eight specialist centres rather than their nearest hospital. Meanwhile 24 continued to provide rehabilitation services.

No hospitals stopped providing stroke care in Manchester but patients identified as possible stoke victims within four hours of developing symptoms are taken to one of three specialist centres – one of which provides 24/7 care.

The new research, published in The British Medical Journal, examined data concerning more than quarter of a million stroke patients living in urban areas in England, including almost 18,000 in Manchester and almost 34,000 in London.

“Other urban areas should seriously consider adopting a similar model”

Naomi Fulop

The authors compared stroke survival from both regions before and after the reconfiguration of services with the average for the rest of England.

They found that every year, London’s centralised stroke services save around 96 patients who would have died under standard treatment.

But the researchers from University College London, the University of Manchester, King’s College London and the Guy’s and St Thomas’ NHS Foundation Trust, found no significant change in the lives saved in Manchester.

Meanwhile, both areas showed a “significant” reduction in the amount of time patients spent in hospital - with patients in London spending 1.4 fewer days laid up on a ward and those in Manchester reducing their hospital stay by two days.

“The changes in London save around 96 stroke patients every year who would likely have died under a non-centralised system,” said lead author Professor Stephen Morris of the UCL Department of Applied Health Research.

“The 96 patients per year figure represents the additional lives saved by centralisation over and above the lives saved by improvements to stroke care nationally.”

Professor Naomi Fulop, also of UCL’s Department of Applied Health Research, added: “Our study shows that radical centralisation of acute stroke care in cities saves lives and reduces time spent in hospital.

University College London

Naomi Fulop

“It may seem counter-intuitive for an ambulance to drive a critical patient straight past the nearest hospital, but it saves lives.

“While an individual may feel that losing their local hospital’s stroke unit is bad for them, going to a specialised centre further away actually increases their chance of surviving a stroke,” she said.

“Now that our paper has clearly shown the benefits of centralisation in London, other urban areas should seriously consider adopting a similar model,” she added.

In England an estimated 125,000 people have a stroke every year and 40,000 die as a result.

 

Readers' comments (1)

  • Whilst I recognise anecdotal evidence is just that, I have a friend who suffered a stroke whilst on holiday in London & was treated in one of these specialised units where early scanning and thrombolysis were available. A few days post-CVA the 'good news' was that they'd woken up, although unable to speak. 2 months later they were up and about/independent, with some, still potentially retrievable with SALT, writing/comprehension difficulties.
    I'm know the patient, and his family, are eternally grateful they were able to receive prompt and specialist treatment.

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