Stroke care shakeup has saved lives and money, says study

Stroke care shakeup has saved lives and money, says study Closing stroke units in many London hospitals and sending patients to a few specialised centres has been a success

Closing stroke units in many London hospitals and sending patients to a few highly specialised centres instead has saved money and hundreds of lives, according to a study.

Since July 2010, ambulances have often bypassed the nearest hospital to take patients with stroke symptoms to one of the eight hyper-acute stroke units in the capital. Before that, patients could have been taken to any of 30 hospitals for initial treatment.

Patients now spend the first 72 hours in one of the specialist units and afterwards may be moved to one of the larger number of hospitals that provide continuing care and rehabilitation.

Closing wards and, in particular, accident and emergency departments in hospitals has been unpopular with the public and politicians. This week a high court judge overturned a proposal endorsed by the health secretary, Jeremy Hunt, to close the A&E department and some other wards of Lewisham hospital, in south London. The legal action had been brought by campaigners strongly opposed to any change.

But the reorganisation of stroke care, recommended in a report from the former health minister Lord Darzi in 2006, happened with little fanfare or protest.

The study, published in the journal PLoS (Public Library of Science) One, shows that the reconfiguration has been a success. Researchers from UCLPartners – an academic health science partnership led by University College London – found that patients' survival rates at 90 days after a stroke had risen from 81.5% to 88.7%.

Stroke survival had improved across the UK, but the researchers calculated that, allowing for that, a 12% reduction in deaths could be credited to the reorganisation.

They said that meant 400 lives had been saved in London since 2010 as a result of the reconfiguration. If the whole country followed suit, 2,100 lives could be saved each year, they estimated.

NHS bills were also lower, even though there were costs involved in setting up the new system. The researchers estimated that the NHS saved £811 per patient, mostly because patients recovered better and faster.

There is still a question over whether the benefits found in London would be as great elsewhere in the country, where hospitals are further apart.

"Our study shows that a system directing patients to high-quality stroke units in the first 72 hours following stroke saves lives and money," said one of the authors, Dr Charlie Davie, director of neuroscience at UCLPartners and consultant neurologist at the Royal Free London NHS foundation trust.

"The centralised model worked well in London because of the high-density population and the hospital distribution that permitted ambulance travel times to remain within viable limits.

"Our study could be used to support the implementation of similar models in other large populations, and further research is ongoing to examine whether the London model is viable in other geographical and clinical settings." Guardian