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Should stroke care be centralised?

Should stroke care be centralised?
8th August 2014

There have been calls to centralise stroke care in hospitals around the country by using specialist units in an attempt to provide better care for patients.

As many as 96 lives were saved when this approach was adopted in eight locations in London, according to a study by University College London (UCL). 

The current procedure, which has been in place since 2010, is that when someone experiences a stroke in the capital, they are sent to one of the eight 24-hour specialist units, instead of the nearest hospital to them. 

Such locations were designed so they are no more than 30 minutes away from anyone living in London.

Researchers from the university analysed stroke survival rates in both London and Greater Manchester - where there are also these specialist units - before and after the changes were implemented. 

It transpired centralisation in London lowered death rates by 1.1 per cent - which worked out as 96 lives - but there was not the same effect in Greater Manchester.

This approach also lowered the amount of time individuals remained in hospital - a day and a half in London and two days in Manchester. 

Senior author Professor Naomi Fulop of the UCL Department of Applied Health Research said: "It may seem counter-intuitive for an ambulance to drive a critical patient straight past the nearest hospital, but it saves lives. Now that our paper has clearly shown the benefits of centralisation in London, other urban areas should seriously consider adopting a similar model."

Dr Shamim Quadir from the Stroke Association is quoted by BBC News as saying centralising stroke care in hospitals in other big cities across the UK "has the potential to save thousands of lives".

This research was commissioned by the National Institute for Health Research Health Services and Delivery Research Programme. It was funded by the Department of Health and scientists from UCL, the University of Manchester, King's College London and the Guy's and St Thomas' NHS Foundation Trust carried it out. 

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