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Patients with acute stroke are less likely to be admitted directly to a stroke unit when hospital beds are scarce: a Swedish multicenter register study
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. 1 Department of Medicine, Ga¨llivare Hospital, Sweden.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
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2017 (English)In: European Stroke Journal, ISSN 2396-9873, E-ISSN 2396-9881, Vol. 2, no 2, p. 178-186Article in journal (Refereed) Published
Abstract [en]

Introduction: It is well established that managing patients with acute stroke in dedicated stroke units is associated with improved functioning and survival. The objectives of this study are to investigate whether patients with acute stroke are less likely to be directly admitted to a stroke unit from the Emergency Department when hospital beds are scarce and to measure variation across hospitals in terms of this outcome.

Patients and methods: This register study comprised data on patients with acute stroke admitted to 14 out of 72 Swedish hospitals in 2011-2014. Data from the Swedish stroke register were linked to administrative daily data on hospital bed occupancy (measured at 6 a.m.). Logistic regression analysis was used to analyse the association between bed occupancy and direct stroke unit admission.

Results: A total of 13,955 hospital admissions were included; 79.6% were directly admitted to a stroke unit from the Emergency Department. Each percentage increase in hospital bed occupancy was associated with a 1.5% decrease in odds of direct admission to a stroke unit (odds ratio = 0.985, 95% confidence interval = 0.978-0.992). The best-performing hospital exhibited an odds ratio of 3.8 (95% confidence interval = 2.6-5.5) for direct admission to a stroke unit versus the reference hospital.

Discussion and conclusion: We found an association between hospital crowding and reduced quality of care in acute stroke, portrayed by a lower likelihood of patients being directly admitted to a stroke unit from the Emergency Department. The magnitude of the effect varied considerably across hospitals.

Place, publisher, year, edition, pages
Sage Publications, 2017. Vol. 2, no 2, p. 178-186
Keywords [en]
Stroke, stroke unit, hospital bed occupancy, hospital admission, stroke care, emergency care, emergency department, bed crisis, The Swedish stroke register
National Category
Neurology
Identifiers
URN: urn:nbn:se:umu:diva-153857DOI: 10.1177/2396987317698328ISI: 000446624400010OAI: oai:DiVA.org:umu-153857DiVA, id: diva2:1268341
Funder
Norrbotten County CouncilAvailable from: 2018-12-05 Created: 2018-12-05 Last updated: 2019-05-16Bibliographically approved

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Darehed, DavidStegmayr, Birgitta

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