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Study: Centralised stroke services save lives


6 August 2014

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Commissioners for urban areas should consider centralising stroke services to save lives and thousands of hospital days, researchers from University College London have suggested. 
Centralising stroke services in London has saved around 96 stroke patients per year who would have died under standard hospital treatment, research published in the BMJ has revealed. 

Commissioners for urban areas should consider centralising stroke services to save lives and thousands of hospital days, researchers from University College London have suggested. 
Centralising stroke services in London has saved around 96 stroke patients per year who would have died under standard hospital treatment, research published in the BMJ has revealed. 
Anyone suffering a stroke in London is taken to one of eight 24/7 Hyper Acute Stroke Units (HASUs) rather than to the nearest hospital. HASU locations were chosen so that no Londoner is ever more than half an hour’s ambulance ride away. 
Specialist stroke staff then assesses the patients with brain imaging and treatments where appropriate. After the initial HASU visit, patients are taken to one of 24 Stroke Units. 
Professor Naomi Fulop from the UCL Department of Applied Health Research said that although it sounds counter-intuitive, having an ambulance bypass the nearest hospital saves lives. 
“While an individual may feel that losing their local hospital’s stroke unit is bad for them, going to a specialised centre further away actually increases their chance of surviving a stroke,” she said. 
“Now that our paper has clearly shown the benefits of centralisation in London, other urban areas should seriously consider adopting a similar model.” 
A similar scheme in Greater Manchester had no effect on mortality but reduced the average hospital stay by two days. 
Stroke patients seen within four hours of developing symptoms are taken to one of three specialist stroke centres in Greater Manchester. 
However, only one of the centres is open 24/7. Other patients are taken to one of ten District Stroke Centres. 
Data from 258,915 stroke admissions across England between 2008-2012 was analysed for the study including 17,650 around Manchester and 33,698 in London. 
Stroke survival from before and after reconfiguration was compared with the English average, which has been improving since the publication of the National Stroke Strategy for the NHS in December 2007. 
Centralisation saved a total of 8,842 hospital days in Greater Manchester and 12,766 in London. 
Professor Tony Rudd of Guy's and St Thomas' NHS Foundation Trust, National Clinical Director of Stroke in England, who led the London centralisation, said: “This paper makes a strong case to centralise acute stroke care in large centres able to offer high quality care regardless of the day or time. 
"The benefits in terms of reducing mortality are not achieved just by focussing on patients who might be suitable for clot busting treatment but by ensuring that all patients are looked after in a large, well-staffed specialist unit. We need to spread this model to all urban areas where a hub and spoke model is an option.”

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