Gubitz G, Phillips S, Aguilar E
Departmentof Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
J Stroke Cerebrovasc Dis. 1999 Sep-Oct;8(5):330-5. doi: 10.1016/s1052-3057(99)80007-x.
Problems with patient flow through our Acute Stroke Unit prompted us to examine delays in discharging patients. We analyzed age, gender, stroke type, length of stay, discharge disposition, and cause of discharge delay for all patients with transient ischemic attack, cerebral infarction, and intracerebral hemorrhage admitted to the Acute Stroke Unit between January 1, 1994 and December 31, 1996. During this time, 729 patients were admitted; 58% were male. The median age was 71 years, and the median length of stay was 13 days (range 1 to 241 days). Seventy-five percent of the patients were admitted with cerebral infarction, 15% with transient ischemic attack, and 10% with intracerebral hemorrhage. Overall in-hospital case-fatality was 13%. Discharge was delayed in 29% of survivors. Of the survivors, 24% went home after alterations to the home environment, 62% were transferred to a rehabilitation facility, and 14% to a nursing home. Based on current figures, the cost of these delayed discharges was approximately 1.5 million Canadian dollars per year. Such "bed-blocking" necessitated admitting patients to nonneurological nursing units, which interfered with the operation of the Acute Stroke Unit. Costs could be reduced by expediting the transfer of patients when acute care is no longer needed.
患者在我们急性卒中单元的流转问题促使我们对患者出院延迟情况进行调查。我们分析了1994年1月1日至1996年12月31日期间入住急性卒中单元的所有短暂性脑缺血发作、脑梗死和脑出血患者的年龄、性别、卒中类型、住院时间、出院去向及出院延迟原因。在此期间，共收治729例患者；其中58%为男性。年龄中位数为71岁，住院时间中位数为13天（范围1至241天）。75%的患者因脑梗死入院，15%因短暂性脑缺血发作入院，10%因脑出血入院。总体院内病死率为13%。29%的幸存者出院延迟。在幸存者中，24%在对家庭环境进行改造后回家，62%被转至康复机构，14%被转至疗养院。根据目前的数据，这些延迟出院每年造成的费用约为150万加元。这种“床位占用”情况使得患者不得不被收治到非神经科护理单元，这干扰了急性卒中单元的运转。当不再需要急性护理时，加快患者转运可降低费用。
