Upgraded Acute Stroke Care Including Thrombolysis Is Associated with Reduced Length of Hospital Stay among Non-Stroke Patients

Abstract

Background: Implementing thrombolytic therapy in a stroke unit (SU) profoundly affects the resources available to all patients admitted for suspected acute stroke. We examined the benefits of an acute stroke service to non-stroke patients in terms of length of hospitalization, and estimated the economic impact in terms of derived costs. Methods: We performed a historical follow-up study of 792 non-stroke patients admitted to our SU for suspected stroke before, during and after implementing thrombolysis as part of our service. Data on demographic and clinical characteristics, including imaging data and final diagnoses, and length of stay (LOS) were collected prospectively. Multivariate logistic regression analysis was performed to identify variables associated with LOS. Results: Median LOS for non-stroke patients in the SU decreased from 43.8 h (interquartile range, 19–96) to 23.5 h (16–44) after implementing thrombolytic therapy. Total hospital LOS for non-stroke patients decreased from 52.7 (22–147) to 28.7 (21–124) h during the same period. Initial magnetic resonance imaging was associated with shorter LOS in the SU. The derived cost reductions from shorter LOS reduced the costs of implementing recombinant tissue plasminogen activator treatment. Conclusions: Stroke care reorganization following the introduction of thrombolytic treatment was associated with a 50% reduction in LOS for non-stroke patients admitted to the SU. Reduced LOS in the SU for non-stroke patients could further add to the cost-effectiveness of thrombolytic treatment.