Nandakumar Nagaraja, MD

Moynihan B, Paul S, Markus HS. User Experience of a Centralized Hyperacute Stroke Service: A Prospective Evaluation. Stroke. 2013


To improve access to thrombolysis, 8 Hyperacute Stroke Units (HASU) were implemented in London in 2010. All suspected acute stroke patients were diverted by ambulance to the HASU. After the hyperacute phase, patients were discharged home or transferred back to the local stroke recovery unit on day 3. Because of the potential for worse patient experience with the discontinuity of care from early repatriation to local stroke unit, the authors prospectively evaluated the patient and carer experiences using a modified Picker Questionnaire.
The study found higher satisfaction rates among both patients and carers. Patients discharged home from HASU had higher satisfaction rates compared to those transferred back to the local stroke unit. Thrombolysis rates increased from 6 to 9.4%. The onset to treatment time was unchanged but there was significant decrease in the door to needle time from 65 to 49 minutes. 
The study highlights that patient and caregiver satisfaction is not significantly compromised while achieving higher thrombolysis rates in HASU setting. It also highlights the fact that patients and carers are looking for highest level of care and they do not seem to mind travelling longer distances if better and higher level of stroke care is provided. Increased volume of activity was thought to be one of the factors related to shorter door to needle time. This is probably comparable to the Primary and Comprehensive stroke centers in US with higher volumes of strokes having better door to needle times compared to other centers.