Chapter 58 Acute stroke units and teams

Abstract

This chapter focuses on the treatment of patients with focal cerebral ischemia, which accounts for about 85% of most etiologies of strokes, and outlines the different existing types of stroke care that range from services providing acute stroke care during the first days after stroke to the service only providing rehabilitation. The setting that is defined by geographically clearly marked/restricted wards, where stroke patients are admitted and cared for, includes the “acute intensive stroke unit” or “acute stroke intensive care unit,” Acute stroke units seem to improve care by themselves by alternating investigations as well as secondary prevention and reducing length of stay. One approach for reducing the in-hospital delays by obtaining specialized medical care and by providing acute stroke care for stroke patients is the formation of so-called acute stroke teams, which are also referred to as stroke code teams in analogy to cardiac code teams. Stroke rehabilitation units only accept patients after the acute phase of the disease; that is, with a delay of usually 7 days or more, and focus exclusively on rehabilitation. Comprehensive stroke units combine acute and rehabilitation stroke care. These three approaches to stroke unit care tend to be more effective than conventional care in a general medical ward. Apparent benefits can be shown for units with acute admission policies as well as for those with delayed admission policies and for units offering a period of rehabilitation of several weeks.