Abstract
Stroke is a medical emergency and time after onset is brain function. Therefore, it is essential to make every effort to develop all urgent correspondence full system for acute stroke. In 1997, NINDS (National Institute of Neurological Disorders and Stroke) presented the response time after the arrival of a stroke patient to a hospital by emergency, followed by AHA (American Heart Association) their a guideline 2000. The goal should be to (1) perform an initial patient evaluation within 10 minutes of arrival in the emergency department, (2) notify the stroke team within 15 minutes of arrival, (3) initiate a CT scan within 25 minutes of arrival, (4) interpret the CT scan within 45 minutes of arrival, (5) ensure a door-to-drug (needle) time of 60 minutes from arrival, and (6) transfer the patient to an inpatient setting within 3 hours of arrival. Should the patient meet the criteria for thrombolysis, quick access to stroke expertise within 15 minutes and to neurosurgical expertise within 2 hours of hospital arrival is recommended. Stroke patients have longer length of hospital stay. Stroke management is needed for the where team, (1) home doctor, (2) acute hospital, (3) rehabilitation hospital, and (4) care house. After the introduction of a clinical pathway dedicated for acute ischemic stroke of varying severity in 1995, the average length of hospital stay of both stroke and non-stroke patients declined in our hospital. Rehabilitation in the recovery stage can be done in the specialized rehabilitation hospitals within Kumamoto due to inter-hospital cooperation. Our acute stroke team can concentrate on the treatment of stroke in the acute stage (within 1〜4 weeks from the onset). We have been developing this stroke management system based on an acute stroke unit with referral to a rehabilitation unit in another hospital (inter-hospital referral model) in contrast to the conventional system with a combined acute and rehabilitation stroke unit in a single hospital (intra-hospital referral model). Eight-hundred and six patients (459 male, 347 female, 71.0 ± 12.2 years-old) with acute ischemic stroke were admitted to three hospitals between May 1999 and April 2000. The average NIHSS (National Institutes of Health Stroke Scale) was 8.2 (median 5). The length of hospital stay was 17.3 ± 17.4 (median 14) days. Two-fifth of all patients were discharged to their homes, and 76.6% of them were discharged within 14 days. Another 2/ 5 patients were transferred to rehabilitation hospitals, and 62.1% of them were discharged within 21 days. The reduction of length of hospital stay was achieved by the use of the clinical pathway and the inter-hospital cooperation.
