ACUs Definition And Composition

Although the ASU employs specialized technologies in one location, it is at the same time a nonphysical construct in which specialists engage in dedicated stroke care that is primarily behaviorally dependent, as opposed to technologically driven. ASUs should be staffed by those who have an interest and specialized training in the care of patients who have suffered from stroke. This training requires a significant amount of dedicated continuing medical education, as well as additional clinical training, such as clinical fellowships. Stroke units should employ computerized databases, have written care protocols, and have the capability to monitor patients frequently. An ASU can acquire the characteristics of an ICU, with invasive and complex monitoring equipment; however, it is more likely that the ASU will employ minimal specialized clinical monitoring and focus on basic cardiac monitoring. Physicians in the ASU can be intensivists or general internists, even though most physicians who direct or run the ASU are neurologists. All physicians responsible for specialized care in these units should have special education and advanced training in the management of the sequelae of stroke. In the future, those physicians designated as medical directors of ASUs should have additional training and certification in neurovascular neurology.

Any physician managing an ASU should be familiar with guidelines pertaining to standard care of patients who have suffered a stroke. Information regarding the performance and management of the ASU should be immediately available, such as written admission and discharge protocols, patient census, outcome data, educational, and continuing medical education records for all members of the unit staff. The configuration and size of an ASU can vary. However, the unifying principle is organized care of patients who have suffered a stroke, delivered by trained professionals who specialize in the care of these patients.

Many studies within and outside the United States have examined the issue of how an ASU affects outcomes. Still, the consensus about what constitutes an ASU is often unclear. This lack of standardization is important when attempting to abstract data on ASU efficacy and to identify and describe specific practices and skills that result in measurable improvements in outcome.

In the literature, the following are considered essential elements of an ASU (36,37):

  • Staffed with a special interest in stroke or rehabilitation;
  • Routine involvement of caregivers in the rehabilitation process;
  • Coordinated multidisciplinary team care that incorporates meetings at least weekly;
  • Information provided to patients and caregivers; and
  • Regular programs of education and training.

In our opinion, the following elements are also essential components of an ASU:

  • Accessible geographical location;
  • Capability to continuously monitor cardiac function, blood pressure, and oxygen saturation;
  • Specialized nursing staff;
  • Small patient-to-nurse ratio;
  • Multidisciplinary stroke team headed by a physician, with expertise in cerebrovascular disease;
  • Dedicated beds;
Table 1 Number of Beds and Staffing Ratios for 175 Stroke Units, United Kingdom National Audit, 2001-2002
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