Stroke Patient Care Setting Requirements

Optimal Care Setting for Stroke Patients

The American Heart Association recommends that patients with acute stroke should be treated on an inpatient stroke unit as soon as possible, ideally within 24 hours of hospital arrival, as it is associated with significant reductions in death, death or institutionalization, and death or dependency compared to care in non-specialized units 1, 4
Stroke unit care benefits persist regardless of the patient's sex, age, or stroke severity, with reductions in death (OR=0.76), death or institutionalization (OR=0.76), and death or dependency (OR=0.80) compared to care in non-specialized units 4, 3

Patients selected for decompressive hemicraniectomy should be transferred to an intensive care unit or neuro step-down unit for close monitoring prior to surgery, as recommended by the American Stroke Association 1

Neurological assessments should include level of consciousness, worsening symptom severity, and blood pressure at least hourly, or more frequently as the patient's condition requires, according to the American Heart Association guidelines 1, 5
Changes in status requiring immediate notification of the stroke team include: level of drowsiness/consciousness, change in Canadian Neurological Scale score by ≥1 point, or change in NIHSS score by ≥4 points, as recommended by the American Stroke Association 1, 2
Continuous oxygen saturation monitoring is needed to identify hypoxia and early development of complications, as suggested by the American Heart Association 5

The core interdisciplinary team should include physicians, nurses, occupational therapists, physiotherapists, speech-language pathologists, social workers, and clinical nutritionists with stroke expertise, as recommended by the American Stroke Association 3
Hospital pharmacists should be included to promote patient safety, medication reconciliation, and education, according to the American Heart Association guidelines 3
Stroke units should have staffing ratios of ≥3.0 registered nurses per 10 beds, as lower ratios have been associated with higher mortality, as suggested by the American Heart Association 5

For facilities without a dedicated stroke unit, priority should be given to clustering patients, forming an interdisciplinary team, providing access to early rehabilitation, implementing stroke care protocols, conducting case rounds, and offering patient education, as recommended by the American Stroke Association 4, 3
Standardized stroke orders or integrated stroke pathways improve adherence to best practices, according to the American Heart Association guidelines 6, 7

Delaying transfer to a stroke unit, as earlier admission (within 2 days) has been associated with fewer complications, as suggested by the American Heart Association 5
Admitting patients to an intensive care unit solely for monitoring after r-tPA, which may be unwarranted and unnecessarily expensive when appropriate stroke unit care is available, as recommended by the American Stroke Association 5
Failing to recognize that approximately 25% of patients may have neurological worsening during the first 24-48 hours after stroke, necessitating close monitoring regardless of care setting, as suggested by the American Heart Association 6, 8