Is centralisation the solution to stroke care?

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Specialist units should be the way forward, claims research

A recent study by University College London suggests that stroke care needs to be centralised in large specialist units to deliver optimum services.

The overhaul of services in London, which created focused stroke care at eight specialist centres, has been proven to save an additional 96 lives a year. Although similar changes have been piloted in Greater Manchester, there has been less of an impact. England’s national stroke director Prof Tony Rudd said the research showed centralisation of care should now be rolled out to all urban areas.

Centralisation has resulted in an increased survival rate in London – up by 1.1% which is the equivalent of 96 lives, however this is not reflected in Greater Manchester. Length of time patients spent in hospital reduced across both locations – by 9% in Manchester and 7% in London.

Specialist results

Since 2010, anyone suffering a stroke in London is taken to one of eight 24-hour specialist units rather than their nearest unit across the capital’s network of 30 hospitals. Patients are assessed immediately and given brain scans and clot-busting treatment if needed. The units were selected to ensure that no Londoner is more than a 30 minute ambulance journey away. In comparison, at Greater Manchester, only stroke patients seen within four hours of developing symptoms are taken directly to one of three specialist stroke centres with other patients taken to one of 10 district centres. Only one of the specialist centres is open 24 hours a day and no hospitals stopped providing stroke services entirely as a result of centralisation.

Study co-author Prof Naomi Fulop told BBC News “It may seem counter-intuitive for an ambulance to drive a critical patient straight past the nearest hospital, but it saves lives.” Prof Rudd agreed saying “This paper makes a strong case to centralise acute stroke care in large centres. We need to spread this model to all urban areas.”

Dr Shamim Quadir, of the Stroke Association, added “It has long been recognised that rapid, specialist medical treatment for stroke patients saves lives and reduces costs for the NHS. Centralising stroke care in hospitals throughout other large UK cities has the potential to save thousands of lives.”